Endorsement Form for the Mother-Friendly Childbirth Initiative(MFCI)
I have read and am adding my name as an endorser of the Mother-Friendly Childbirth Initiative created by the Coalition for Improving Maternity Services (CIMS), July 1996.
- Signed_________________________________________________________________
- (Please list any degrees or credentials pertinent to your endorsing the MFCI)
If you are endorsing for an organization (your board must approve the endorsement), please write its full name:
_______________________________________________________________________
__I would like to have my name/credentials displayed inconjunction with the document.
__I would not like to have my name/credentials displayed inconjunction with the document.
Address________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Phone ___________________________________
Fax _____________________________________
E-mail ___________________________________
Website __________________________________
- Note: This contact information is strictly for use by CIMS and will not be given out or used for any other purposes.
- Please print this (or the downloadable version) and mail to:
-
Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607
Telephone: 888.282.CIMS (2467) or fax to 904-285-2120.
- Important note: Do not return this form by e-mail. For legal purposes, we must have your signature on file.
Thank you for your support,
The Coalition for Improving Maternity Services