Name *

First Name

Last Name

Phone *

(###)

###

####

Are you an active Birth in Color Doula? *

Doulas who are currently a part of Birth in Color and are in good standing, including being up to date on dues, are able register for these trainings for free.

YES

NO

Did you Previously Train with Birth In Color?

Doulas who previously trained with Birth in Color in the last two years, but are not actively a Birth in Color doula make a donation of $10 for this training to help cover refreshments. Please indicate your training date in the notes section.

YES

NO

Please indicate your training date:

MM

DD

YYYY

Are you a trained doula with another organization outside of Birth in Color?

Doulas who did not previously train with Birth in Color in the last two years, can make a donation of $50 to help with refreshments and credit hours.

YES, I AGREE TO PAY $50

NO