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CIMS Online Donation Form

By financially supporting CIMS you are helping make Mother-Friendly care a reality. We appreciate that supporting CIMS with a financial contribution is a significant and generous commitment. To make it as easy as possible, you can choose between making a contribution online through our PayPal account or by returning our downloadable Donation Form (PDF). For your convenience, the downloadable form offers the option to make your total contribution among one or more installments.

Donation

* Mandatory fields
*First name
Middle Initial
*Last name
*Organization
 

Contact Information

*e-Mail
Phone
Alternate Phone
FAX
Address 1
Address 2
Town/City
Zipcode
 

Additional Information

Credential/Degree
Website
 

Mother Friendly Childbirth Initiative Endorsement Information

I/We Endorse the MFCI as:
I am a:
 

I have read and want to add my/my organization's name as an endorser of the MFCI

*Please initial here:
Address
City
State / province
Postal code
Country
Comment
*Designate my gift in support of:
*Amount ($USD)
 

If this is an Honor Birth donation:

Honoree First Name
Honoree Last Name
 

Email address is provided strictly for CIMS to notify honoree that a donation was made in their name

Honoree Email Address

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Coalition for Improving Maternity Services. P.O. Box 33590. Raleigh, NC 27607-3590. Telephone and fax: 866-424-3635   

CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).