ArizonaMidwives.com

Midwifery Listing Sign-up Form

Please copy the following text and paste it into an email along with the required information. You can send the email to cowley(at)addr(dot)com (replace the (at) with an @ and the (dot) with a "."...we do this to control spam).

Your Name:

Your Email Address:

Your Mailing Address:

Phone numbers you want listed online (home, office, mobile, etc.):

Your Listing Choice: Plan A (Free Basic Listing) or Plan B ($75 Upgraded)

Your Education (degrees, titles, etc.):

Your Experience:

Any special skills you want to mention?

Internet search keywords you want included on your listing:

Additional Comments:

Thank you for your application! We will contact you shortly with more information on when to expect your entry to be listed and any payment information (if it applies to the plan you choose).

We accept two methods of payment:

  1. PayPal (click on the link below).
    If this fails, you can direct your payment to cowley(at)addr(dot)com

  2. Check sent to the following address:
      Tim Cowley
      2141 E Remington Pl.
      Chandler AZ 85249