NCIM Membership

The National Council of Indigenous Midwives (NCIM) is made up of a diverse group of midwives from all regions of Canada, representing First Nations, Inuit and Métis communities.

NCIM Membership is voluntary and must be renewed annually. Information collected from this form is strictly for the purpose of establishing the NCIM membership database, which is shared with the Canadian Association of Midwives. It will not be distributed in any way.

If you have any comments or suggestions about this form, or if you wish your information to be removed from our database, please email: admin@indigenousmidwifery.ca

NCIM Membership

Membership *

NCIM Paid work - $ 100.00 (includes Sales Tax of $ 0.00)

NCIM Student - $ 25.00 (includes Sales Tax of $ 0.00)

NCIM Student (Unable to Pay Fees) - $ 0.00 (includes Sales Tax of $ 0.00)

NCIM Aboriginal Midwife Working Under Exemption (ON) - $ 100.00 (includes Sales Tax of $ 0.00)

NCIM Unable to Pay Fees at this Time - $ 0.00 (includes Sales Tax of $ 0.00)

NCIM Elders - $ 0.00 (includes Sales Tax of $ 0.00)

Total Amount

Email Address *

NCIM Membership

First Name *

Last Name *

Street Address *

Supplemental Address 1

City *

Country *

Province *

Postal Code *

Primary Phone

Work Phone and Extension

Other Phone Number

Birth Date *

(for demographics)

How do you Self-Identify? *

First Nations	Métis
Inuit	Indigenous

What is/are your nations?

Are you a beneficiary of an Inuit land claim?

Yes No

Are you registered with a provincial Métis organization or Métis Nation?

Yes No

Please name the community where you practice(d)

Please describe your current clinical practice status *

Please indicate the Midwifery education program you are currently attending

I am currently in an Indigenous midwifery apprenticeship or community-based program

I am currently enrolled in a university-based program

Other

Please indicate the Midwifery education program

When do you anticipate graduating from your program?

Where, in terms of geography do you plan to seek employment when you complete your Indigenous Midwifery program?

If you plan to set up practice after graduation, where would you like to do that?

What title do you use to identify as a midwife? *

For example: Aboriginal Midwife, Indigenous Midwife, Aboriginal Registered Midwife, Indigenous Registered Midwife, etc.

What other community and professional activities are you involved in?

How were you trained as a midwife? *

Apprenticeship or community-based education program, or a blended model

University-based education program

Other

Select all that apply

Would you be interested in joining the NCIM Core Leadership in the future? *

Yes No Maybe – I’d like to learn more

Do you consent to being included in a general map of Indigenous midwifery in Canada, without any specific identifiers? *

Yes No

NACM would like to show where its members are working throughout the country.

Preferred Communication Method

Phone
Email
Postal Mail
SMS

Would you be interested in volunteering for NCIM?

Yes No

How would you like to volunteer?

Privacy Policy

The National Council of Indigenous Midwives (NCIM) and the Canadian Association of Midwives (CAM/ACSF) values the privacy of our members and those who visit our website. We are committed to protecting the privacy, confidentiality, accuracy and security of personal information that we collect, use, retain and disclose in the course of carrying out our activities and providing services.

Using the principle of what a reasonable person would consider appropriate in the circumstances, NCIM and CAM/ACSF recognizes the importance of keeping personal information confidential using reasonable safeguards and limited to that which is necessary for the purpose for which it is collected. Names, addresses and other personal information held by NCIM and CAM/ACSF will not be given to individuals, organizations or corporations outside NCIM and CAM/ACSF at any time for any reason except with consent of the individual member or as required by law or allowed under the Federal Personal Information Protection and Electronic documents Act (PIPEDA).

Cancellation policy

There will be no reimbursement for cancellation of NCIM Supportive Membership.

Privacy Policy *

Agree. I have read and accept the Privacy and Cancellation Policies.

Teaching/Training	Graduate studies	Professional association
Research	Policy development	Advocacy work
Cultural work	Other

Privacy Policy

Cancellation policy

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