2026 WI-AIMH Membership Registration

2026 WI-AIMH Membership Registration Form
WI-AIMH is the professional home for those who work with and on behalf of pregnant people, infants, young children and their families. We are excited to welcome you into our community. (Or welcome you back!)

Please complete this form to register for 2026 WI-AIMH Membership.
Your membership begins upon payment and expires on December 31, 2026.

This form accepts debit/credit cards and Paypal.
If you need to pay by check, are registering more than 10 people, or have any questions, please contact Sarah Bruhn: SBruhn@wiaimh.org
Name:*

First NameLast Name
Personal Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Preferred Email Address:*

Confirmation EmailPlease confirm your email address.

Please select your membership type: *

Individual MembershipFor 1-3 people

$60.00 Total memberships:
Item subtotal:$0.00

Student MembershipFor full-time undergraduate students (minimum of 12 credits) or graduate students (minimum 8 credits). Proof of full-time status required (e.g., a screenshot of your class schedule or a photo of your student ID). Students must register indivdually.

$30.00

Group MembershipFor groups of four or more individuals registering together. You may coordinate with colleagues or friends to take advantage of the group rate, you do not need to work at the same organization. Please note: group memberships must be paid for in a single transaction.

$45.00 Total # of group members:
Item subtotal:$0.00

Enter coupon

Total

$0.00

Please upload proof of full-time student status. You can upload a picture of your student ID or a screenshot of your class schedule.

Cancelof
By clicking "Next," you agree to receive our monthly newsletter, Early Relationships Matter, and occasional updates on events or promotions. You may unsubscribe at any time. Please add info@wiaimh.ccsend.com to your email contact list. WI-AIMH does not share your information with third parties.

Contact Information for Additional Group Members

Please enter the names and email addresses of the other people you are registering for group membership.
Member #2 Name

First NameLast Name
Email Address
example@example.com
Member #3 Name

First NameLast Name
Email Address
example@example.com
Member #4 Name

First NameLast Name
Email Address
example@example.com
Member #5 Name

First NameLast Name
Email Address
example@example.com
Member #6 Name

First NameLast Name
Email Address
example@example.com
Member #7 Name

First NameLast Name
Email Address
example@example.com
Member #8 Name

First NameLast Name
Email Address
example@example.com
Member #9 Name

First NameLast Name
Email Address
example@example.com
Member #10 Name

First NameLast Name
Email Address
example@example.com
By clicking "Next," you agree that your group members will receive our monthly newsletter, Early Relationships Matter, and occasional updates on events or promotions. They may unsubscribe at any time. Please encourage your group members to add info@wiaimh.ccsend.com to their email contact list. WI-AIMH does not share your information with third parties.

Payment Information
Amount Due at this Time:

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

2026 WI-AIMH Membership Registration Form

Contact Information for Additional Group Members

Payment Information