We're glad you're interested in becoming a part of BirthLink! To join by mail, print out this page, fill it out, and send us the completed form, along with a check payable to BirthLink for the appropriate amount. If you have any questions, feel free to call us at (847) 733-8050.

Are you a new or renewing member?

I'm a new member    I'm a renewing member   

What Membership Level would you like?

Supporting Member...$35	Sole Practitioner...$95	Small Business Member...$195
Strategic Partner...$495	Affiliate Member...$995

Number of additional listings: (Please attach a separate sheet of paper to submit more than two listings. Thanks!)

______ Additional Listings...$45 each   

Membership Fee Total:______________

	First Listing:	Second Listing:(if applicable)
Name:
Credentials:
Title:
Company:
Address:
City:
State:
Zip:
Phone:
Fax:
e-mail:
Web site:
Referred by:
Geographical area served:
Type of services:
Training & Background:

Please mail the completed form with your check to:

BirthLink, PMB 339, 1555 Sherman Avenue, Evanston, IL 60201