Non-Practicing 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

Would you like to receive notifications on transfer of care requests?
 Yes    No

Phone ex: (xxx) xxx-xxxx

Mobile ex: (xxx) xxx-xxxx

Personal Information

Birth Date

Are you enrolled in Medavie Blue Cross for the purposes of the Interim Federal Health Program (IFH)?
 Y    N

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

When was your last MESP certification?

Please indicate the name of your educational School/college/university that you attended

Are you currently a Preceptor?
 Y    N

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

Please indicate the name of your educational School/college/university that you attended

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).

The information collected in this section will be leveraged as we move forward with various MABC initiatives throughout the membership year and begin to seek member direction for association activities. The answers given will be associated with your member profile but will not be visible to the public.

The practice related information collected may be leveraged as aggregate data to help inform MABC’s advocacy efforts and program and policy development activities.

Which areas of MABC’s work are you interested in helping to shape or inform? (Select all that apply. This helps us understand members’ interests and may inform future engagement opportunities)
 Midwifery model of practice  
 Scope of practice  
 Workforce sustainability and retention  
 Compensation and funding models  
 Education and training  
 Integration, system planning and health leadership  
 Disability justice and accessibility  
 Privileging, access and hospital integration  
 Other areas of midwifery systems work  
 I am not interested at this time  

Would you be interested in MABC leadership or governance roles in the future? (e.g. Board of Directors, committees, advisory groups. Please note that this is not an application or commitment, it simply helps MABC understand leadership interest across the membership)
 Y    N

Would you be willing to help MABC connect with clients who may be interested in sharing their lived experience of midwifery care for public awareness or advocacy initiatives?
 Y    N

Which of the following best describes your current clinical practice?
== select == Primary practice or clinic-based care Locum-only practice Combination of primary practice and locum work Not currently providing clinical care

Are you currently using your midwifery training exclusively in non-clinical roles? (e.g. education, health system leadership, policy, planning, research)
 Y    N

Which regional health authority do you primarily practice in? (If you practice in more than one, please select your main location)
== select == Vancouver Coastal Health Fraser Health Island Health Northern Health Interior Health Provincial Health Services Authority Not Applicable

Which option best describes your current practice arrangement? (Midwifery practice models vary across regions and communities; please select the option that best reflects how you practice most of the time.)
== select == Collective midwifery practice - Shared, midwifery only group practice Collaborative interprofessional practice - Working in formal partnership with other provider types e.g., family physicians, OBs, NPs Multidisciplinary team-based clinic - Integrated team model with multiple provider types and shared care Solo midwifery practice - Independent, single provider practice Service contract practice site - Midwifery services delivered under a Ministry funded service contract - rural, remote, urban, or community based Locum practice - Short-term or temporary clinical coverage Other practice model

Professional Activities: Please describe any elected or appointed positions you currently hold, or have held within the past five years, in your community or at the provincial level

Member agreements documents

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

• Code of Conduct
• Membership Fee Schedule
• Membership Policy
• Suspending and Revoking Membership Policy
• Policy On Commercial General Liability Insurance
• Risk Management Policy: Reporting To MPP

 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 insured with BMS Canada Risk Services)

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