Workshop Application Instructions

Please print and fill out the application form below and send it with a $150 deposit to the following address:

The Farm Midwifery Workshop Program
Attn:Pamela Hunt P.O. Box 217 Summertown, TN 38483

When we receive your application and deposit, we will send you a packet which will include a curriculum/schedule for the workshop, a book list, and a list of things you need to bring. The deposit of $150 goes towards the workshop fee ($50 will be non-refundable). It will be non-refundable for cancellations made within 30 days before the workshop. The remaining fees should be paid 10 days before the workshop starts.

Please send payment in Money Orders or Certified checks in U.S. funds. Make checks payable to: The Farm Midwifery Workshop. If you have any questions please contact us.

Workshops for Enrollment

Midwifery Assistant Workshop

Advanced Midwifery Workshop

Workshop for Midwives: Common Sense and Tradition

IV Therapy Workshop

Neonatal Resuscitation

Herb Workshop

Personal Information


Name_________________________________________________________________________________

Address_______________________________________________________________________________

State & Zip________________________________ Phone #_________________________________

e-mail_____________________________________ Level of Education _______ Age _____________

I have my Cardio-Pulmonary Resuscitation Certificate. Date received: ________

On separate page, please tell us what is your experience related to midwifery so far?

Transportation

Shuttle Service from Nashville Airport $85 one way $170 both ways

Airline _____________________ Flight #____________________ Arrival Date/Time ____________________

Accommodations


I have accommodations already

I would like to sleep in the dorm facility. (Dorm is Free for the first 8 applicants in each class except for Herb workshop)

Herb Workshop Dorm, ($18/night)___________

I would like to sleep in a private room. $25/night/student $35/non-student/partner

I would like a list of local accommodations

 

Financial

Deposit Amount: _____________________________________

Lab fee of $45 for Advanced workshop

I agree to pay the balance of _____________ 10 days before the workshop starts.

I have enclosed a total of __________ to cover _____ shuttle, _____ private room, _____ books.

Workshop Deposit / Total Fee _____________

 

Signature______________________________________________________Date______________

 

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