Workshop Registration

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Workshop Registration

Please submit this form to register for your module workshop.

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* Indicates required question

Email *

Your email

Date: *

MM

/

DD

/

YYYY

Name: *

Your answer

Which Module workshop are you registering for? *

Choose

Module 1

Module 2

Module 3

Module 4

Module 5

Module 6

Module 7

Module 8

Have you paid for your next module? Payment can be made here: https://www.texasmidwives.com/ecommerce/education-modules/enrolled-after-july-15,-2017.asp *

Yes

No

Is your student membership up to date? You can renew you membership here: https://www.texasmidwives.com/ecommerce/atm-memberships/studentannualdues.asp *

Yes

No

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