Please print and fill out the application form below and send it with a $150 deposit to the following address:
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@themacisp.net
or call:
931-964-2472 (Mornings please)

Send applications to:
Midwifery Workshops
Attn: Pamela Hunt
P.O. Box 217
Summertown, TN 38483

Application Form

Midwifery Assistant Workshop (Date)_____________.

Advanced Midwifery Workshop (Date) ____________.

Workshop for Midwives: Common Sense and Tradition (Date)_____________.

IV Therapy Workshop (Date)_____________.

Neonatal Resuscitation (Date)_____________.

Name________________________________________________________________

Address__________________________________________________________

State/ Zip+four___________________Phone #_______________________

e-mail_________________________


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 ($75 each way) to and from the Nashville Airport. Yes______No_____

$75 one way __________$150 both ways _________

Airline ____________________ Flight #___________________

Time and date of arrival _______________

I would like to sleep in the dorm facility. _______________ (free for the first 8 applicants in each class)

I would like to sleep in a private room. ________

Deposit made: _____________________________________

Lab fee of $45 for Advanced workshop. _________

I agree to pay the balance of: _____________ 10 days before the workshop starts.

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

workshop deposit or total fee_____________.

Signature_________________________________Date______________