The Farm Midwifery Workshops

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)

Please include/email a picture with your application.

Midwifery Workshop Application Form (Please check the workshop you plan to attend)

Midwifery Assistant Workshop (Date) $925

March 7-13, 2010 ____ April 11-17, 2010 ____ May 2-8, 2010 ____ June 20-26, 2010____ Aug. 1-7, 2010 ____

September 19 -25, 2010 ____

Neonatal Resuscitation - April 19-20, 2010 ____ $275

Herb Workshop - May 19-22, 2010 ____ $475

Workshop for Midwives: Common Sense and Tradition - May 23-27, 2010 ____ $785

Advanced Midwifery Workshop - August 22-28, 2010 ____ $965

Watsu Class ____ $35 (included in the price of the Advanced and Common Sense workshops)

Name_______________________________________________________________

Address_____________________________________________________________

City _______________________________________ State __________ Zip ________________________

Phone # _______________________________ Cell Phone #______________________________________

Email Address _________________________________________________________________

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 _______________

Accomodations

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/workshop participants______$35/non-student/partner______

I would like to rent a cabin $400/$560 per week (contact us for availability) _____________

Please specify if you have any food or cat allergies. _______________________________________

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

books_________.

I agree to pay the balance of __________ 10 days before the start of the workshop.

Signature_________________________________Date______________