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NILMDTS Registration

Please Note: Only your name, email, areas served, and phone numbers will be seen by the public. All other information will remain confidential.
*Please provide a valid mailing address so we can mail your training manual.

Full Name *
Position*
Address *
City *
Country *
State *
Zip/Postal Code *	(use 5 digit zip code)
Phone *
Mobile Phone *
Studio/Work Phone
Email *	Provide only one email address
Check the box(s) showing what you will provide families. *	CD of photography Slide Show or DVD of photography
Have you been convicted of a felony? *	Yes: No:
Check the box(s) showing what languages you speak.	English Spanish French German Chinese Japanese Korean
Are you a member of PPA (Professional Photographer’s Association)? *	Yes: No:
Do you carry an insurance policy as either a full-time or part-time photographer? *	Yes: No: **
State & Sales Tax License	State License #
Website URL / Porfolio URL
Business Name
Years In Business
Sponsor	[ only required if you are applying as a photographer assistant. Enter the name of the photographer you will be assisting.]
Areas Served (ie hospitals, within 10 miles, metro area, etc..)
Other Information (ie hospitals, within 10 miles, metro area, etc..)	Please provide in detail why you would like to join NILMDTS. Additionally, please provide to our Membership Application Committee details regarding your professional experience, affiliations and/or degrees, as well as the professional photography equipment you use.
Password *
Confirm Password *

**NILMDTS strongly recommends that photographers volunteering in hospitals carry General Liability insurance as well as malpractice coverage. As a benefit of PPA membership, Malpractice Coverage is included. For more details, check out "Benefits" at www.ppa.com.
NILMDTS carries multiple types of an organizational-wide insurance policies however NILMDTS cannot guarantee coverage for every scenario such as gross negligence.

NOW I LAY ME DOWN TO SLEEP is a 501(c)(3) non-profit organization, IRS EIN# 77-0656322.
All proceeds go directly into the operation of this organization to help parents who are experiencing an early infant loss.

©Copyright 2012 NOW I LAY ME DOWN TO SLEEP