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Postpartum Doula Training Registration Form. ALL FIELDS MUST BE COMPLETED!!!
Full Name
Complete Address
Home Phone Number
Cell Phone Number
Email Address
Which Training Are You Registering For?
April 14-15, 2012 in Valencia, CA
May 8-9, 2012 in Denver, CO
June 2-3, 2012 in San Diego, CA
July 18-19, 2012 in Kansas City, MO
Why Do You Want to Become a Postpartum Doula?
List other Professional Affiliations/Certifications
How did you hear about this training (choose ONE)?
Are you already a CAPPA Member?
Yes, I'm a CAPPA Member
No, but I'll become a member before training
Additional Comments/Questions
I understand that I am not registered in the training until I have sent the registration form AND paid for my training.
Understand
I understand that after filling out this form I need to go to the Pay for Your Training page to pay for my training via paypal
Understand
I have read and agree to the Rules and Conditions Below
I Agree
I Do NOT Agree
I understand that there are no refunds for this training. If student cannot attend this training, all funds will be held for 12 months to be applied to a future training taught by Darla Burns. Otherwise, all funds are forfeited.
I understand and agree
RULES AND CONDITIONS:
*By submitting this registration form you agree to the following:
  • I understand that there are no refunds for classes but I can transfer to another course with Darla Burns within 12 months of the original course date with approval from Darla Burns.
  • I understand that I must pay for my training in full at least 30 days before the training by going to www.douladarla.com/pay-for-your-training.html
  • I understand that I should not make non-refundable travel reservations until Darla Burns has confirmed the workshop 14 days prior to the course.
  • I understand that I must be a CAPPA member before I can become certified as a CAPPA  Postpartum Doula. (You can obtain membership at www.cappa.net)
  • As a participant of this training, I agree to allow Darla Burns/CAPPA  to do the following:
  1. Publish my name, address, phone number, and email address for the trainee class list & referral list. 
  2. Take photographs of the training which may include me, as well as allow the trainer and CAPPA to use these photographs for promotional purposes online and in print.
  3. Use quotes from my training evaluations (which I may fill out anonymously) for promotional purposes online and in print.
  • I understand that I may not record the training workshop (audio or video).  I may take photographs only with the express permission of the trainer and the participants.
  • I may not reproduce, publish or distribute any materials in the training manual.
  • I may not reproduce, publish or distribute any materials from the certification packet, other than for the purpose of fulfilling my certification requirements (i.e. copying the evaluation forms for my clients to fill out)
  • I understand that this course is only one step in becoming a CAPPA Certified Postpartum Doula.  There are several other steps that must be completed by the student after the training in order to be eligible for certification by CAPPA.
  • I understand that I must attend all days of the training.  If I miss any portion of the training, I will not receive a certificate of completion and/or CEUs.
  • I understand that I must be at least 18 years old to get certified as a CAPPA Postpartum Doula
 

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