REGISTRATION FORM Which of the following describes you?* L&D nurse/CNM/physician - not University of Mich. employee L&D nurse - UM employee L&D nurse - St. Joseph employee - group rate CNM/physician - UM employee CNM student/med student - UM Name* First Last Email* Cell Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe L&D nurse/CNM/physician - not University of Mich. employee Price: $400.00 L&D nurse - UM employee Price: $135.00 CNM/physician - UM employee Price: $350.00 L&D nurse - St. Joseph employee - group rate Price: $350.00 CNM student/med student - UM Price: $325.00 Is there anything special we should know to help you have a great doula training?Would you like to stay connected with our mailing list? We touch base monthly with a roundup of new blog posts, helpful career tips and training updates.* Yes please No thank you By registering for this training, you agree to Heart Soul Birth Pros’ refund and photo release policies: Refunds for the birth doula workshop, minus a $200 cancellation fee, will be issued if you notify Birth Kalamazoo of cancellation one calendar month or more before the first day of the birth doula workshop (e.g. by October 1 for a workshop that begins November 1). There are no refunds issued if notification is received less than one calendar month before the training. All payment plans must be completed before the first day of the training, or the registration may be transferred to a future training for an additional fee, as noted below. The standard refund policy applies to all payments made leading up to the training. Optionally, participants who cannot attend, or who cannot complete their payment plan, may credit their payment toward a future birth doula workshop with the same trainer, for an additional fee of $100. This can be done at any time before the first day of the originally scheduled workshop. The make-up doula training must be attended within one year of the original training, or all fees will be forfeited. By registering for this seminar, you also agree to the photo release policy: I agree that my image, in photos taken during this workshop, may be used for advertising, promotional and educational materials (online and in print). I understand that I release all rights and privileges to the images. I understand that my name will not be used with my image, and therefore will not be searchable. I understand that by checking agree, I agree to my image’s reproduction and that I am not under any obligation to be paid any fees or royalties from its printing and/or usage. Do you agree to the above policies?* Yes, I agree. Total $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.