Midwifery Workshop Application Form (Please check the workshop you plan to attend)
Midwifery Assistant Workshop (Date) ________________ $935
Neonatal Resuscitation - (Date)_________ ____ $345
Herb Workshop - May 16-18, 2013 ____ $545
Workshop for Midwives: Common Sense and Tradition - May 19-23, 2013 ____ $795
Advanced Midwifery Workshop - August 25-31, 2013 ____ $975
Watsu Class ____ $35 (included in the price of the Advanced and Common Sense workshops)
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 _________
Do not make plane reservations until you receive confirmation that you are in the workshop.
would like to sleep in the Clinic Dorm facility. _______________ $12/night/student
Herb Workshop - Community Center Dorm, ($20/night)___________ (herb workshop only)
I would like to sleep in a private room.
I would like to rent a cabin/house $400/$600 per week depending on size
(contact us for availability) _____________
Please specify if you have any food or cat allergies. _______________________________________
I have enclosed a total of __________ to cover deposit____________, shuttle________,
private room___________, books_________.
I agree to pay the balance of __________ 30 days before the start of the