ICAN of Colorado Membership Form

ICAN of Colorado Membership Form

 

YES! I want to support normal birth and enjoy

the benefits of ICAN membership!

 


o          $30 Basic Subscriber (1 year)       

                In addition to receiving ICAN's newsletter, the Clarion, you will be supporting an all-volunteer international

                organization, which educates families in need of birth, cesarean, and VBAC information. Basic Subscribers in

                Colorado can also add a listing on our local Directory of Birth Professionals.

               
o           $80 Professional Subscriber* (1 year)           

Includes all of the benefits of Basic Subscription PLUS a listing on ICAN's national

Professional Subscriber Network. ICAN's national website receive 4000 to 5000 hits per month,

so this is an excellent marketing tool for professionals who work with and support childbearing families.

* Professional Subscription applicants MUST print out and send in the application packet with this form

and their payment. Click HERE  for more information and a printable application packet.

 

o           $150 Childbearing Years Member (5 year subscription)

                              
o           $300 Childbearing Years Member (10 year subscription)
   
o            $500 and up Lifetime Subscriber
               

o           $ _______ Additional donations are welcome, needed, and tax deductible! (see receipt below)

 

Thank you for your support!

Please make checks payable to ICAN of Colorado

3449 Eliot Street, Denver, CO  80211

 

Member Information

 

Name: _____________________________________________                          Date: ______________________

 

Address: ______________________________________________________________________________

 

City: ____________________________________  State: _______   __           Zip: ________________

 

Phone: (           ) ___________________       Email: ________________________________________

 

 

Receipt for Charitable Donation

 

Name: ___________________________________________          Date: ____________________

 

Amount of Donation: $ ________________ ICAN of Colorado Tax ID # 061241254