Registration Page

Space is limited. Please register soon to assure your place!

If you have questions about course content, call or email Amy Gilliland at (608) 225-4738 or amylgilliland@charter.net.

To register, print out the registration form on your printer and complete the necessary fields, or copy and paste it into an email to amylgilliland@charter.net.

Mail completed form with a $350.00 tuition check or US Money Order. Make checks payable to Midwest Doula Trainers.

OR If you pay by credit card, you can charge the entire course fee through a PayPal account. (More information is on the Workshops page.)

You are considered to be registered for the workshop when we receive your payment and your registration form.

Please make sure that you receive a email back from Amy within a few days to confirm your registration.

Registration Form

Midwest Doula Trainers
attn: Amy Gilliland
2829 Sylvan Avenue
Madison, WI 53705

Full Name:____________________________________________________________________________

Name you would like us to call you (nametag):_________________________________________

Address:_________________________________________________________________________

City:______________________________________________________________________________

State/Province:_______________ Zip/Postal Code:__________________

Phone:__________________________________________________________

Email:___________________________________________________________

Number of births attended:_______________________________________

Certifications/Experience:__________________________________________________________

___________________________________________________________________________________

Nursing School and year in program: ________________________________________________________