JM Birth Consultants

Promoting Family-Centered Maternity Care

1. Submit completed Registration Form.

2. Pay online with your Credit Card using PayPal or mail a check to the JMBC Program Coordinator - checks can be made out to JM Birth Consultants
 
3. Upon receiving the completed Registration Form, the JMBC Program Coordinator will mail you a confirmation letter.

Any questions regarding workshop content, registration process or deposit fees contact JMBC Program Coordinator:

Michele Peterson -  703-350-2056
5850 Cameron Run Terrace
Apartment 826
Alexandria, VA 22303

michele@jmbirthconsultants.com

Starting in 2010 JM Birth Consultants will add an $10 Late Registration Fee to registrations received less then 2 weeks before the start of the workshop.

The following information provides JM Birth Consultants with helpful information used to personalize each workshop for the specific attendees:
First Name
Last Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone() -
Evening Phone() -
E-mail Address
Workshop Date & Location
Educational Background: [degree(s), Certification(s), etc.]
Volunteer activities and/or empolyment:
My questions/hopes & expectations/information needed:
Payment: (DEPOSIT or PAYMENT IN FULL)
Payment Type (PayPal or Check)

PAYMENT IN FULL - Breastfeeding Workshop
$75.00
Doula Workshop DEPOSIT + Breastfeeding Workshop PAYMENT ($250 plus $7 PayPal Fee) The remaining balance is due the first day of the Doula workshop
$250.00
Doula Workshop PAYMENT IN FULL + Breastfeeding Workshop PAYMENT ($400 plus $12 PayPal Fee)
$400.00
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