Birthing Gently Doula Services Doula Training Mail-in Registration Form

Birthing Gently Doula Services DONA Doula Training Registration Form

Name

First:

Last:

Middle Initial:

Address1

Address2

If applicable, APT or PO Box

City

State

Abbreviation only please

Zip Code

8 digit + 4 if known

Phone Number

Please include Area Code

Payment Type

Check* $450.00
DL Number and Issuing State
Birth Date

YYYY

Money-Order $450.00

*If paying by check, please include your state issued
drivers liscense number. This helps protect both you
and Birthing Gently against fraud.

Class Dates
and City Locations

	Please type city, state, and dates you are registering for.

By checking this box, I certify that I have read and understood the
cancellation policy of Birthing Gently Doula Services regarding
registration cancellation for the DONA Doula Training Workshop.
Yes

By checking this box, I certify that all information included in this
registration is true. Birthing Gently Doula Services is not held
responsible delays in the mail system, printer errors, computer
errors, or other problems out of the realm of control of
Birthing Gently Doula Services. I also acknowledge that
Birthing Gently is not responsible for any mistakes made
by me on this registration form that may cause me to be
disenrolled/enrolled incorrectly into a class.
Yes

Please be sure to fill this form out completely. This form is designed to be
filled out online and then printed on YOUR printer.
At this time we can only accept check or money orders via the regular mail
system. The mailing address is:

Birthing Gently Doula Service c/o Tara Powe
PO Box 5373
Bradford, MA
01835

Any questions can be directed to tara_powe@birthinggently.com