Coalition
for Improving Maternity Services
ENDORSEMENT
FORM from THE NORTHLAND
BIRTH NETWORK
FOR
THE MOTHER-FRIENDLY
CHILDBIRTH
INITIATIVE
(MFCI)
I
have read the MFCI and I 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_________________________________________________________
Date_____________________
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 in
conjunction with
the document.
I
WOULD NOT like to have my name/credentials displayed in
conjunction
with the document.
Name______________________________________________________________________________
Address____________________________________________________________________________
Phone/Email________________________________________________________________________
Note:
This information is strictly for use by CIMS and will not be
given
out or used for any other purposes.
_______________________________________________________________________
Please
mail to CIMS, P.O. Box 2346, Ponte Vedra Beach, FL 32004
904-285-1613
888-282-CIMS www.motherfriendly.org
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