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BWIB New Member form
Please complete this form if you are interested in joining BirthWise In Birmingham. After reviewing all entries we will be in touch regarding details for an in-person open house where we hope to learn more about each other. Thank you for your interest.
* Please note that all potential new members need to be vaccinated against Covid-19.
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* Indicates required question
Name:
*
Your answer
Email address:
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Your answer
Phone number:
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Your answer
Currently I am a:
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Birth doula
Postpartum doula
CLC - Certified Lactation Consultant
IBCLC -
Midwife
Student midwife
Placenta encapsulator
Birth photographer
Other:
Required
Tell us more about your interest in joining BWIB?
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Your answer
As a co-op we share the responsibility of managing social media accounts, email contacts, and other logistical aspects of a co-op. What skills and talents do you hope to bring to BWIB?
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Your answer
One of the benefits of joining a co-op is growing your interests/ practice. What do you hope to gain by joining BWIB?
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Your answer
Birth doulas ONLY: How many births have you attended?
Your answer
Birth workers: Where did you receive your training and are you certified through that agency?
Your answer
What is your belief on vaccinations?
*
Your answer
Is there anything we didn't ask that you would like for us to know?
Your answer
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