DONA Approved Birth Doula Training Registration

Name*

First Last

Email*

Phone Number*

Alternate Phone Number

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Choose how you would like to pay:*

We require that payment be made before class begins to secure your spot. Please select the class below to pay the course fee in full, OR, if you'd like to arrange a payment plan (or pay by check at the first class meeting), please select the option to make a deposit and choose the option for your payment arrangement. If you need a payment plan, we can work with you; select that option and we'll contact you to arrange a plan.

Pay in full online via credit card.
Pay $100 deposit online via credit card; complete payment by check or cash at first class meeting.
Pay $100 deposit online via credit card; please contact me to arrange a payment plan for the remainder.

Choose the training you'd like to register for (pay in full).

Choose the training you'd like to register for ($100 deposit).

Would you like to buy a meal & snacks for the 3 or 4 days of training? ($10/day)*

If so, indicate the day(s) below for which you'd like to purchase meal & snacks.

Yes
No

What days would you like to buy meal?

Day 1 Meal
Day 2 Meal
Day 3 Meal
Day 4 Meal

Would you like to include the Breastfeeding Training for Doulas (optional) for an additional $75?*

Yes
No

Total

$0.00

Please enter your credit card details.*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Email

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