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 confirmation letter 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 one month 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)

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)

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 _________

Do not make plane reservations until you receive confirmation that you are in the workshop.

Accommodations

I 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.
$25/night/workshop participants______$35/non-student/partner______

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 workshop.

Signature_________________________________Date______________