WomanCraft Registration Form

WomanCraft Midwifery Education Program
Registration Form

(after completing your registration you will be returned to the WomanCraft home page. Please us the buttons on the right to pay you deposit and set up your payment plan subscription. You may also send payments via postal mail. You registration is not complete until your deposit has been received.)

Your Name

Your Email Address

Street Address

City and State

Zip Code

Home Phone number

Cell Phone number

Are you CPR certified?

Yes
No

Are you NRP certified? (Neonatal Resuscitation)

Yes
No

Please provide a short list of your experience or trraining with birth and midwifery.

Highest level of school completed

If registering for the Beginning Midwifery Retreat or Advanced Retreat
Will you be staying here in the yurt?

Yes
No
Maybe

Do you have nay food allergies we should be aware of?

What course would you like to register for

Will you be sending your deposit via paypal today?
(Your registration will not be completed until
you have send your deposit via paypal or postal mail)

Will you be paying your tuition in full today?

Yes
No

Would you like the Basic Course monthyl payment plan
($120. a month for online and $195. a month for local
option after deposit)?

Yes
No

Would you like the Basic Course- Local Option weekly option
($50. week for 39 weeks after deposit)?

Yes
No

Would you like the Advanced Course payment plan
($200. a month for 8 months after deposit)?

Yes
No

If registration is for the Beginning or Advanced Retreat
Will you be sending you $100. deposit via paypal today or postal mail?

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