In Service of Birth Registration Form
In Service of Birth is a dynamic continuing education series for birthworkers of all backgrounds and experience levels to expand their knowledge of the mystery, science, and personal journey of childbirth and motherhood. Course taught by Zoë Etkin, somatic coach and bodyworker. In-person or virtual attendance, depending on preference and distance from location: Memphis, TN.
Name *
Phone Number *
Email Address *
Terms of Service: Content in this course comes from the instructor's extensive background of research, training, and experience. Tools created in the course are, in some cases, proprietary. Students attending the course are required to agree to only utilize these tools and this information with explicit credit to the instructor, or to anyone whom she references/attributes credit to in the course. Since this information is going into a currently yet to be published book, it is of utmost importance to honor this request. Failure to do so will be consider a copyright violation and breach of trust/agreement. *
Required
Which organizations have you trained with? Please denote if birth, postpartum, or other subject.  *
What do you want to learn about the most? What draws you to embodiment, somatics, spiritual birth, etc.? *
Course(s) attending: *
In Service of Birth courses are $150 per course. If you plan to attend all three, you can pay at one time or monthly. If you plan to attend one or two, please pay monthly. All fees are due on the first of each month a course is held to reserve your spot. Filling out this form alone does not secure registration. Payment must accompany this form in order to register. Please select payment plan: *
Required
Will you be attending the course...
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms