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