Birth Professional Training Online Registration Form

Date:

Contact Information

First Name
Last Name
Address
City
Province
Postal Code
Home Phone
Work Phone
E-mail

 

Additional Information (optional)

 

Nurse, Labor and Delivery

Nurse, other

Midwife

Physician

Midwife Assistant

Childbirth Educator

Childbirth Doula

Lactation Professional (Specify )

Postpartum Doula

Other

 

Send information on area accommodations

 

Yes, I would like to stay at Immanuel's Retreat Center (west of Edmonton, AB)

 

I have dietary restrictions

 

Workshop Choices

 

Childbirth Doula Workshop: Sept. 29-31, 2006 at Immanuel's Retreat Center                   $350.00

 

Postpartum Doula Workshop: Oct. 13-15, 2006 at Immanuel's Retreat Center                   $350.00

 

Childbirth Educator Workshop: Nov. 10-12, 2006 at Immanuel's Retreat Center               $350.00

 

Childbirth Educator Workshop: March 2-4, 2006 at Immanuel's Retreat Center               $350.00

 

Childbirth Doula Workshop: March 15-17, 2006 at Immanuel's Retreat Center                 $350.00

 

Postpartum Doula Workshop: April 21-23, 2006 at Immanuel's Retreat Center                 $350.00

 

Early Bird Discount for registrations received one month prior to workshop                     $ 25.00

 

Advanced Workshop Choices

 

Advanced Body Awareness Workshop: October 28, 2006 at Immanuel's Retreat Center    $100.00

 

Advanced Body Awareness Workshop: March 24, 2007 at Immanuel's Retreat Center       $100.00

 

Early Bird Discount for registrations received six weeks prior to workshop                         $ 8.00

Refund Policy

(a) If written notice of withdrawal is received by Mother Care before registration close (two weeks prior to workshop date), Mother Care will retain the lesser of 10% of the total workshop fees or $50.

(b) If written notice of withdrawal is received by Mother Care after registration close (two weeks prior to workshop date), Mother Care will retain the lesser of 50% of the total workshop fees or $200.

(c) Participants are not eligible for refunds after commencement of workshop.

(d) If the workshop is cancelled, participants can either choose to register for an upcoming Mother Care workshop or apply for reimbursement of paid workshop fees.

I understand and agree with the above refund policy.

 

Click submission button below to pay online using your PayPal account or credit card.

 
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