2024 CA workshop application

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Name
Home/Shipping Address
Midwifery Education Status: (check any that apply)
Practice Status: (check any that apply)
Are you currently a practicing Traditional Midwife or Direct Entry Midwife?
Are you currently an apprentice?
Do you plan to pursue CPM certification?
Do you plan to become licensed or certified to practice in your state?
If you are not currently practicing or apprenticing, are you looking to gain apprenticeship or placement?
Are you a Doula or a Child Birth Educator?
Is midwifery legal in the state/country you plan to practice in?
Do you have relationships and support from the other midwives/doulas in your area?
Are you a part of your state midwifery organization(s)?
Are you NRP certified?

Enrollment Agreement

I understand and agree to the following: initial each line to indicate you have read and understand each statement

Initial each line below to indicate you have read and understand each statement

I understand this is an application for attendance, admittance is not guaranteed and I will be notified of the decision by email. If I'm admitted I will receive a link to register for my chosen workshop in that acceptance email.