Homebirth Confidence Building Workshop - Booking Form (Wellington Region NZCoM)

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1st and follow-up Zoom Workshop will be facilitated by Claire Eccleston and this will be funded by NZCoM Wellington Region for members. There are two *morning* options - Wednesday 10th or Thursday 11th November for the first zoom, then Wednesday 17th or Thursday 18th November for the follow-up zoom.

There will be then be a further in-person, practical homebirth confidence workshop session for midwives held in the Hutt Valley on Wednesday 8th December 2021 morning, facilitated by local midwives and homebirthers.

-- This is for all midwives and midwifery students working in any setting.
-- Intention is to be about midwifery sharing to boost confidence and skills in the homebirth setting.

If you have not already been contacted by Vida to confirm your place (from previous advertising that we have put out) please complete the form below before end Monday 8th November 2021.

Email *

Your FULL Name (First Name and Surname) *

Which of the options would you like to book? *

Limited spaces on Thursday option available as at Monday 8th Nov... several spaces still available on Wendesday option

Wednesday 10th November 2021 - 9:30am until 12:30pm with follow-up Wednesday 17th November 9:30am - 10:30am

Thursday 11th November 2021 - 9:30am until 12:30pm with follow-up Thursday 18th November 9:30am - 10:30am

Are you also available for the Practical Workshop on morning of Wednesday 8th December 2021? *

Time will be from 9:30am - 12:30pm

Yes

Maybe

Are you a ....? *

Midwifery Student

Midwife Member of NZCoM

Midwife - not a member of NZCoM

Other:

If a midwifery student, your student number please

Only for midwifery students, otherwise leave this blank :)

Your Membership Number for NZCoM *

Please put "not a member" if you are not as there will be a cost involved

Your Midwifery Council Number (if applicable)

8 hours MW Council elective education approval granted for full attendance

Please give your contact telephone numbers below in case we need to contact you to discuss this further *

Thank you. PLEASE NOTE: we will contact you again to confirm your place on the workshop as spaces are limited. Not everyone will be able to attend, but we may be able to run something similar in the future.

Any issues in the meantime, please email vida@birthhub.org or telephone 04 589 7802

A copy of your responses will be emailed to the address you provided.

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