Birth and Postpartum Doula Training Registration Form

Birth and Postpartum Doula Training Registration Form

Please ensure that you have thoroughly read the Doula Training brochure before registering for either the birth or postpartum doula training program. To download the brochure please copy the following link: http://birthwellbirthright.com/2292-2/

Please note: When you have completed the registration form, you will be redirected to PayPal to pay a non-refundable 50% deposit. The balance of payment will be due approximately 30 days before the start of your chosen training. If you wish to organise a payment plan, please email Tanya or Jenn as soon as possible to arrange. Our contact details are below.

Please feel free to contact either Tanya Cawthorne or Jenn Fontaine if you have any questions.

Jenn Fontaine
LCCE, FACCE, CD(DONA), PCD(DONA), CLE, Lamaze Program Director
Email: Jenn@itsbirth.ca

Tanya Cawthorne
birthwell birthright
LCCE, FACCE, Lamaze Program Director
Lamaze International Board of Directors
Co-founder Lamaze Australia
Lamaze Certified Childbirth Educator

Email: tanya@birthwellbirthright.com
Ph. 0422 067 985

Name (as you would like it to appear on your certificate) Name (as you would like it to appear on your certificate) First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mobile Phone
Home Phone
Daytime Phone
Email address
Please tick the appropriate box below.

Please tick the appropriate box below. I am registering for the in-person birth doula training ONLY I am registering for the in-person postpartum doula training ONLY I am registering for the birth doula certification pathway (in-person and self-paced program) I am registering for the postpartum doula certification pathway (in-person and self-paced program) I am registering for the birth doula AND postpartum doula certification pathway (in-person and self-paced program)
Please indicate below which in-person training(s) you wish to attend.

Please indicate below which in-person training(s) you wish to attend. MELBOURNE: Birth Doula Training. Friday March 1st to Sunday March 3rd, 9am to 6pm each day MELBOURNE: Postpartum Doula Training. Friday March 8th to Sunday March 10th, 9am to 6pm each day SYDNEY: Birth Doula Training. Friday March 22nd to March 24th, 9am to 6pm each day SYDNEY: Postpartum Doula Training. Friday March 29th to 31st, 9am to 6pm each day
How did you hear about this training? (if someone referred you, please don't forget to write down who!)
Do you have any experience or education in birth?
Is there anything you would like us to know about you?
Do you have any allergies that we should be aware of?
Ticking the box below confirms that you have read the Doula Trainings brochure and agree to the Terms and Conditions.
Brochure can be downloaded here: http://birthwellbirthright.com/2292-2/

Ticking the box below confirms that you have read the Doula Trainings brochure and agree to the Terms and Conditions.
Brochure can be downloaded here: http://birthwellbirthright.com/2292-2/ I have read and agree to the Terms & Conditions.
Please tick the box below if you would like to be added to our mailing list so that you can be keep up-to-date on future training opportunities.

Please tick the box below if you would like to be added to our mailing list so that you can be keep up-to-date on future training opportunities. Yes! I'd like to be added to the mailing list.
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