Form Sample

Training Registration Form

Doula Training Registration Form OLD

Are you registering for yourself or someone else?

Myself

Someone Else

How did you hear about us?

What session would you like to register for?

Registrant's Legal Name

First Name

Last Name

Email Address

Phone Number

Please provide a physical street address in the U.S. where the SMC Training Manual can be sent. Please note we cannot deliver to post office boxes or APO/FPO in the U.S. If your shipping address is outside of the U.S., an handling additional fee of $ 25.00 plus the cost of shipping will be charged prior to shipping the Training Manual.

Mailing Address

Street Address

Unit or Apartment #

City

State/Province

Zip/Postal Code

Country

Education Level

Ethnicity (Optional)

Have you trained as a doula with another program?

Please list the program(s) you have participated in.

In your own words, please tell us what you hope to gain from training as a SMC Full Circle Doula Birth Companion.

Registration Fee

One Full Payment: $1,468.00

Total

Payment Information