Doula Course Application Question Title * 1. Name Question Title * 2. Date Date / Time Date Question Title * 3. Address Question Title * 4. Phone Number(s) Question Title * 5. Email Address Question Title * 6. Hobbies & Interests Question Title * 7. What has led to your interest in birth doula work? Question Title * 8. Do you have any previous experience with birth? Question Title * 9. Do you have children and, if so, what are the story(ies) of their birth(s)? Question Title * 10. Please acknowledge that you understand a deposit of $400 must be received before registration in the doula course is complete. Payment may be made through paypal on our website (www.taoshomebirth.com) or by sending a check to Taos Midwifery, PO Box 1946, Ranchos de Taos NM 87557. If you pay in full before October 1st, you will receive a discounted rate of $750. I understand and agree to the above statement Done