Community Birth Conference: Program Committee Application

AABC and NACPM invite our members to join the Program Committee to help plan the Community Birth Conference.

We strive to have balanced representation on the committee. The information you share on this application will help us do this.

If you have any questions, please contact Kate Bauer, AABC Executive Director, at 215.234.8068 / katebauer@birthcenters.org or Cassaundra Jah, NACPM Executive Director, at 808.283.5373 / executivedirector@nacpm.org

Application Deadline: JULY 7TH

*1.Contact Information:(Required.)

Name: *

Organization:

City/Town: *

State/Province: *

Email Address: *

Phone Number: *

2.Are you a member of AABC and/or NACPM? (check all that apply)

AABC

NACPM

Other (please specify)

3.Please share why you want to serve on the Program Committee and the experience or skills you may bring.

4.The committee will set regularly scheduled meeting times, usually on a weekday. Can you commit to participating in these meetings?

Yes

Maybe (please explain)

5.Do you currently serve on an AABC and/or NACPM Committee?

Yes, please specify

6.What is your role in the community birth community? (check all that apply)

midwife

administrator

nurse / birth assistant

doula

lactation consultant

educator

billing specialist

advocate

Other (please specify)

7.What is your primary practice setting?

Birth Center

Home

Other (please specify)

8.How do you identify yourself? (check all that apply)

Member of the Global Majority (includes Asian American (or of Asian descent) or Pacific Islander, Black or of African descent (African American, Afro-Caribbean, etc.), Indigenous to Americas (Alaskan Native, American Indian, Native American), Latina/o/x or Hispanic, Southwest Asian or Northern African, or a person who is of multiple races)

LGBTQIA+

Person with disabilities

Other (please specify)

None of the above

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