2009 – 2010 BCAPOP MEMBERSHIP FORM
“BCAPOP is a non-profit society made up of Pregnancy Outreach Programs (POPs) from across B.C. POPs provide perinatal and early parenting support to women and their families who experience health or lifestyle challenges during pregnancy, birth and the transition to parenting. The BCAPOP supports POPs in their work to enhance maternal and infant health for the long-term benefit of our communities.”
1. Full Voting Membership $200
Any Pregnancy Outreach Program that provides services at no cost to Perinatal families who face challenges.
OR
2. Associate/Individual Membership $50
Any program or individual who is affiliated to or supports the work of pregnancy outreach programs.
1. FULL VOTING MEMBERSHIP - $200.00
BENEFITS
• • • • • • • • Your program will be listed on the BCAPOP website Monthly teleconference calls to share information and support program staff Networking and support to share skills, expertise, information and resources Reduced registration fees at our annual education conference Resource development and/or distribution Representation of programs at regional, provincial and federal tables A vote at our Annual General Meeting Opportunities to participate in the Board or working committees of BCAPOP
By completing this membership your program is agreeing to support the mission statement of BCAPOP above & confirming that you provide perinatal services at no cost. Program Name: Sponsoring Agency: Mailing Address: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Email for correspondence: Coordinator name: Primary location (City/Town): Other communities served: 1
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The following information about your program will help the board in our efforts to support Pregnancy Outreach Programs: Our program is reaching perinatal families who face challenges at no cost: Our program employs Pregnancy Outreach/Peer Support Workers(s): Our program has access to a Registered Nurse: Our program has access to a Registered Dietitian: How many new intakes did your program have last year? Yes Yes Yes Yes No No No No
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Do you have a staff member who would like to participate in the conference committee? Yes Would you or someone on your staff be willing to serve on the Board of Directors? Yes No No
2. ASSOCIATE / INDIVIDUAL MEMBERSHIP - $50.00
Other programs or individuals, for whom membership in BCAPOP is advantageous or who wish to support the work of BCAPOP, are invited to apply for associate membership. Membership entitles you to information & updates within the field of perinatal outreach health from BCAPOP. We thank you in advance for your support.
We would be interested in knowing more about you or your program: I am an individual with an interest in supporting the work of Pregnancy Outreach Programs Yes We are a program associated with the delivery of perinatal services. Yes No No
Please provide a brief description of your interest and/or service provided:
Name: Mailing Address:
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Email Address: ________________________________________________________________ 2
COMPLETION OF MEMBERSHIP APPLICATION
1. Make cheques payable to: “BC Association of Pregnancy Outreach Programs” in the amount of : Full Voting Membership Associate or Individual Membership $200 $50
2. Cheques must be included with and accompany completed membership application forms.
3. Mail completed applications and cheques to:
BCAPOP ATTN: Judi Calhoun- Secretary Bag 999, Hazelton BC V0J 1Y0
4. Membership renewal must be received with full payment by the secretary on or before March 31, 2009. A certificate of membership will be mailed to you upon receipt of payment.
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