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Birth Network of Santa Cruz County Membership

New Members
Complete the Membership information below.
All memberships expire on Sept 30.
About Birth Network of Santa Cruz County membership

General Membership $25
Professional Provider Membership $50 		Renewing Members
Click here to renew your membership.
If you would like to make a donation without becoming a member click below.
DONATIONS
If you are a member or would just like to contribute to Birth Network, you can make your donation here.

Additional Donation OR Enter a donation amount here $

ALL MEMBERS

The following information is required for General Members, Professional Provider Members, and Donors. Your contact information (address, email, phone) is private. Names of General Members and Donors may be listed publicly on this Web site and the Birth Network of Santa Cruz County printed materials unless you request your name not be used publicly, by checking the box below. See our Privacy Policy for more details.

Member Login
Please enter your email address and create a password.  Use this login information in the future to access to your member account to update your member listing, renew your membership, or modify your login information.

Your email address
Password

Contact Information
Please complete all required information.*

*First Name   Please DO NOT use my name publicly
*Last Name
*Mailing Address
*City
*State *Zip
*Phone *Email

NOTES: Please let us know if you would like your donation “in honor of ... ” or “in memory of...”, or other acknowledgment.
(This information may be made public.)
PROFESSIONAL PROVIDER MEMBERSHIP
The following information will be included in your Professional Membership Listing on the Local Providers page on the website and may be used in printed materials. Only include information here that you want available to the public.

First name
Last name
Buiness Name
Address
Address2
City Phone ()  
State Zip
Email Web Address
NOTE: When space is limited, such as in the Pregnancy and Birth Resource Guide, please use the following information for my listing:

1) Phone OR Website

2) Business Name OR Member Name
Professional member and/or business services description. (50 words max). This description should convey all services offered.
Please check headings in which you currently, actively offer classes or services:
Unless you have special training or offer a service beyond the norm, do not check additional heading. For example, Midwives offer childbirth education in their basic services, but unless separate classes are being offered, please do not check childbirth educator.

 Acupuncture
 Breastfeeding
 Child & Family Health Care
 Childbirth Education
 Chiropractic
 Counseling (Prenatal/Postpartum)
 Doula (Birth)
 Doula (Postpartum)
 Massage & Bodywork
 Massage (Infant)
 Midwife (Home)
 Midwife (Hospital)
 OB/GYN & Family Practice w/Obstetrics
 Yoga/Fitness
 Other Resources

Please describe each "other" service in one to three words, i.e. CPR instructor or belly casts.


If more than 3 items are checked above please list the three items which you would like listed in the Pregnancy and Birth Resource Guide.



I have read and endorsed the Mother-Friend Childbirth Initiative. (Required to be a Birth Network Member)


Renewing Professional Members
Check current listings on the Resources page. Completeing the Professional Members section of this application gives permission to use my name/information on the Birth Network of Santa Cruz County Website and other Birth Network of Santa Cruz County publications.

Birth Network of Santa Cruz County is a 501c3 nonprofit organization.

Please review your information carefully. When you click the Submit Registration button below, your information will be saved and you wil be directed to a page where you may choose to pay by check or continue on to PayPal. PayPal allows you to pay with Visa, Mastercard, or with your Paypal account.

Listings will appear online after payment has been received and listing has been reviewed.