ICAN of Central Iowa: Membership Form

ICAN of Central Iowa Subscription Form

Thank you for your desire to join ICAN of Central Iowa and support our mission of improving maternal-child health!

There are two ways to join us!

Fill out Part One of the form below, click Buy Now, and follow the remainder of the checkout process to pay online with PayPal or a credit card.
Fill out the entire form below, print this page, then mail it - along with a check made out to ICAN of Central Iowa - to ICAN of Central Iowa, c/o Lisa Houchins, 2833 50th St., Des Moines, IA 50310

PART ONE

Supporting Subscription: $30
Five-Year Childbearing Years Subscription: $125
Ten-Year Childbearing Years Subscription: $250
Lifetime Subscription: $500
Basic Professional Subscription: $60
Five-Year Professional Subscription: $270
Lifetime Professional Subscription: $2000

Additional Donation (optional, enter desired amount in box)

Professional Subscribers ONLY:

Business Name:
Title:
Website URL:
Services Provided:
Service Area:

PART TWO (only fill this out if you're going to pay via mailed check)

ICAN of Central Iowa is a non-profit organization whose mission is to improve maternal-child health through education & support.

Website design by Sarah Reid of Wallypop