Invoice: ACNM Region 1, Chapter 1 

Your ACNM chapter needs your membership. We are working very hard to improve communication among CNM’s and to create the conditions necessary for us to achieve recognition as Licensed Independent Practitioners. We need your energy, your ideas, your feedback, and—your support. There are many levels of participation available to you, from “silent supporter” to active officer or committee member. If you have not been a Chapter member recently, please reconsider the option. We hope that these minutes of our December meeting will kindle your interest. Please return this form to us even if you are not joining, so we can maintain our CNM database and send out important announcements to you. Look for our updated website at www.nursemidwivesinmass.org. 

Please return this form to:

Deborah Cordero Fiedler, CNM, Treasurer.                    DATE: ____________________________

1139 Narragansett Blvd., #2 Cranston, RI  02905

Phone:  401-467-0254

(DUES ARE FOR JAN 2001 TO JAN 2002)

PLEASE  CIRCLE THE  ADDRESS, PHONE AND E-MAIL YOU WISH US TO USE TO CONTACT YOU!

NAME:  ____________________________________________________________________

HOME ADDRESS: ___________________________________________________________

CITY, STATE, ZIP CODE: ______________________________________________________

HOME TELEPHONE: _________________________________________________________

E-MAIL:_____________________________________________________________________

PRACTICE (WORK) NAME: ____________________________________________________

ADDRESS: __________________________________________________________________

CITY, STATE, ZIP CODE: _______________________________________________________

WORK PHONE: _____________________________ E-MAIL: __________________________

OTHER CONTACT INFORMATION? (FAX, BEEPER, CELLULAR, ETC)__________________ _____________________________________________________________________________

Chapter work I am interested in doing: (please circle)

 None, I can’t!                               Lobbying                                    Legislative committee

Host a meeting                            Membership                               Bylaws

Present at a meeting                Public relations/Image             Fund-raising