Please print and fill out the application form below and send it with a $150 deposit to the following address:

The Farm Midwifery Workshop Program
Attn: Pamela Hunt
P.O. Box 217
Summertown, TN 38483

 When we receive your application and deposit, we will send you a packet which will include a curriculum/schedule for the workshop, a book list, and a list of things you need to bring.
The deposit of $150 goes towards the workshop fee. It will be non-refundable for cancellations made within 30 days before the workshop.
$50 will be non-refundable.

The remaining fees should be paid 10 days before the workshop starts.

Please send payment in Money Orders or Certified checks in U.S. funds.
Make checks payable to The Farm Midwifery Workshop.
If you have any questions please contact us at:
midwives@midwiferyworkshops.org
or call:
931-964-2472 (Mornings please)

Application Form

Midwifery Assistant Workshop (Date)_____________.

Advanced Midwifery Workshop - August 23-29, 2009 ____________ or August 22-28, 2010__________.

Workshop for Midwives: Common Sense and Tradition - May 23-27, 2010 _____________.

IV Therapy Workshop August 28-29, 2010 _____________.

Neonatal Resuscitation - April 19-20, 2010 _____________.

Herb Workshop - May 19-22, 2010 _____________.

Name_______________________________________________________________________

Address______________________________________________________________________

City __________________________ State ___________________ Zip___________________

Phone # _______________________________ Cell Phone #___________________________

Email Adress _________________________________________________________________

Level of education_______ Age_____________
I have my Cardio-Pulmonary Resuscitation Certificate; Yes___No___ Date received: ________

On a separate page tell us: What is your experience related to midwifery so far?

I plan to use the shuttle ($85 each way) to and from the Nashville Airport.

$85 one way __________$170 both ways _________

Airline ____________________ Flight #___________________

Time and date of arrival _______________ Time and date of departure _______________

I would like to sleep in the dorm facility. _______________

  • (Dorm is Free for the first 8 applicants in each class except for Herb workshop)


  • Herb Workshop Dorm, ($18/night)___________

I would like to sleep in a private room. $25/night/student_____________ $35/non-student/partner________

I would like to rent a cabin (contact us for availability) _____________

I have enclosed a total of __________ to cover shuttle________, private room___________, books_________,

Advanced Lab fee ($40)__________. I agree to pay the balance of __________ 10 days before the start of the workshop.


Signature_________________________________Date______________