Membership Information - Georgia Birth Network

Personal Information

Name:

Address:

City:

State:

Zip:

Contact Information

Email Address:

Cell Phone:

Work Phone:

Home Phone:

Membership Questions

What is the best means to contact you?
Phone E-Mail

Membership Type
Advertiser $65 Group Member $129 Support Member $29
*Fees are prorated for members not joining in July. Consult the pricing chart on the Membership page for your total dues.

Advertisers & Group Members, complete this section:

Website:

Area served:

Certifications:

Business Name:

Choose up to three categories for website listing:
Labor Doula
Postpartum Doula
Childbirth Educator, method:
Chiropractor
Lactation Support
Midwife/Student Midwife
Massage Therapist
Doctor/Nurse, specialty:
Photography
Sales/Retail
Other, describe:

Additional information about your listing:

How did you hear about us?

Designed & Maintained Mike Bowden
All photography provided by In The Moment Photographs