Birth Professional Training Registration Form

Date ________________

Contact Information

Name ___________________________________________________________

Address _________________________________________________________

City ____________________ Province ___________ PC __________________

Home Phone _____________________ Work Phone _____________________

Email ___________________________________________________________

Additional Information (optional)

q       Send information on area accommodations

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

Workshop Choices

q       Childbirth Educator Workshop

q Nov. 10-12, 2006 at Immanuel's Retreat Center                         $350.00

q March 2-4, 2007 at Immanuel's Retreat Center                          $350.00

q       Childbirth Doula Workshop

q Sept. 29-31, 2006 at Immanuel's Retreat Center                        $350.00

q March 15-17, 2007 at Immanuel's Retreat Center                       $350.00

q      Postpartum Doula Workshop

q Oct. 13-15, 2006 at Immanuel's Retreat Center                         $350.00

q April 21-23, 2007 at Immanuel's Retreat Center                         $350.00

q       Early Bird Discount, 

for registrations received one month prior to workshop                 $ -25.00

Advanced Workshop Choices

q       Advanced Body Awareness Workshop

q October 28, 2006 at Immanuel's Retreat Center                        $100.00

q March 24, 2007 at Immanuel's Retreat Center                           $100.00

q       Early Bird Discount, 

             for registrations received one month prior to workshop              $   -8.00

 

Total Workshop Fees                                                                 _______________

Refund Policy

a)     If Mother Care receives a written notice of withdrawal 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 Mother Care receives a written notice of withdrawal 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.

 

 q       I understand and agree with the above refund policy.

 Signature _______________________________________________________

 Make cheque or Money Order payable to Connie Banack. Print this form, complete order and mail with payment to:

Mother Care

4 Lamplight Bay

Spruce Grove, AB T7X 4N2

 Phone/Fax: 780/962-1846

 

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