Question Title

* 1. Name

Question Title

* 2. Date

Date / Time

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 $450 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 $850.

T