Occasionally NARM receives requests for listings of CPMs in specific areas. While NARM will verify that a midwife is a CPM if asked, we cannot release names or any other information without prior authorization. If you would like this information released, please print and sign the form below and mail to:
NARM
5257 Rosestone Dr.
Lilburn, GA 30047
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Release Form I, (print/type name)____________________________________ give permission for NARM to release my name as a CPM, including contact information, CPM number, CPM issue date, and CPM expiration date. This becomes effective on (date)___________________. I understand that to revoke this permission, I must send notice in writing to the same address. Current address:___________________________________________________ Current city, state, zip: ____________________________________________ Current phone: __________________ Current e-mail (if available): _____________________________ Current status: ___ legally recognized (licensed, registered) by state, or___ no legal recognition by state Signature: ___________________________________________________ |