New Temporary - limited scope Sign-up

First Name

Last Name
Your first and last name as they appear on the BCCNM records.

Preferred First Name
If you would like to use a different first name for your online profile please enter it here. This includes removing a middle name.

Contact Information

Address

City

Province
== select == ==Canada== AB BC MB NB NL NS NT NU ON PE QC SK YT ==Outside Canada== OTHER

Postal Code ex: V1V 1V1

E-mail

May we inform you about upcoming MESP workshops when you are due to re-certify?
 Yes    No

Phone ex: (xxx) xxx-xxxx

Mobile ex: (xxx) xxx-xxxx

Fax ex: (xxx) xxx-xxxx

Personal Information

Birth Date

Marital Status
== select == Single Married / Common law

Training, Skills & Services

Are you currently enrolled with Medavie Blue Cross?
 Y    N

Additional Languages
If a language is not listed contact info@bcmidwives.com

When was your last MESP certification?

Are you currently a Preceptor?
 Y    N

Communities served
If your community served is not listed please contact info@bcmidwives.com

Please type the name of your midwifery school - what other degrees and schools did you attend

Additional information: Please include notes you’d like to add to your midwife profile about the communities you serve, etc. The information will be visible to the public (place names in this field will not be searchable).

Member agreements documents

Please read the key documents listed below as they most directly impact your MABC membership and midwifery practice:

• Code of Conduct
• Suspending and Revoking Membership Policy
• Membership Policy
• Risk Management Policy: Reporting to MPP
• Policy on Commercial General Liability

 I have reviewed the governance documents and agree to abide by them as a member of the Midwives Association of BC.  

Proof of Commercial General Liability

The Midwives Protection Program requires midwives practicing in BC to have commercial general liability insurance. If your coverage is with BMS Canada Risk Services, they will provide the MABC office with proof of your coverage. If your coverage is with another provider please upload your certificate of insurance. For further information, please see Commercial General Liability Insurance (CGL) - MABC.

Proof of CGL
== select == CGL ins with BMS Canada Risk Services Other CGL provider: Proof of CGL file uploaded If non-practicing - N/A

Upload proof of CGL certificate of coverage (not required if you are with BMS Canada Risk Services)

Consent for 2.9% Universal Dues

MABC Membership Dues: In order for the MABC to receive your membership dues we ask that you complete the "Consent for 2.9% Universal Dues" form. Please refer to the Membership Fee Policy and Schedule for more information on fees and membership.

This consent form gives permission to the Medical Services plan of BC to deduct the Universal Dues of 2.9% at source and to deposit this fee directly into a designated account of the Midwives Association of BC's.

Please note that you do not need your MSP number in order to fill in the form. Once you begin billing MSP, the MABC office will fill in your MSP number and then fax the completed consent form to MSP. Please print, sign and upload the Consent for 2.9% Universal Dues form

Consent for 2.9 percent Universal Dues

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