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Individual Membership
Annual Membership
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$80
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Individual
Contact Information
Name
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First Name
Last Name
Salutation
Preferred Name / Nickname
Email
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Email Type
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Home
Work
Phone Number
Phone Type
Work
Home
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Employer Information
Employer
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Address
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Address Line 1
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City
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About You
Professional Directory
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Profession
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Doula/Midwife
Consultant
Counselor/Therapist
Education
Family Support
Nursing
Occupational Therapy
Pediatrics
Physical Therapy
Psychology/Psychiatry
Social Work
Special Education
Speech & Language Therapy
Student
Other
Field Employeed
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Child Welfare
Pregnancy and Perinatal Support (Doula/Midwife/OBGYN)
Early Care and Education
Pediatrics
Home Visiting Program
Law/Courts
Mental Health
Part C (Early Intervention, ESIT)
Policy/Advocacy
Retired
Teaching/Faculty (college/university level)
Other
Profession Other
Field Employed Other
IMH Role
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Advocate
Community Organizer
Educator
Management/Administration
Researcher
Service Provider
Student
Supervisor
Other
Years worked with babies, young children and their families
Less than 2 years
2 - 5 years
5 - 10 years
10+ years
Highest Degree Earned
High School/GED
CDA
Associates
Bachelors
Masters
Doctorate
Medical or Law
Gender Status
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Female
Male
Non-binary
Prefer not to say
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