Registration and Confirmation

Workshop attendance is limited to 12 people.  Please call or email for directions. You will receive a phone call or email confirmation that your space is reserved.

Attendance at this workshop is a privilege, not a right. The instructor reserves the right to deny participation in the workshop at any time, in which case a refund would be provided. 

  

Price and Discounts

see Registration Form below

  

Cancellations

There are no refunds after November 1, 2010. If the workshop is cancelled or postponed by the instructor, your money will of course be returned to you. If you choose not to attend after registering and have passed the Novemeber 1 refund date, you may find a replacement for yourself at the workshop though. Refund requests postmarked before that date must be sent in writing to Connie Sultana at the address below or via email to conniesultana@sbcglobal.com.  A $100 materials and processing fee will be retained for cancellations or postponements before or during the workshop.

  

Workshop Cancellation

There needs to be a minimum of 6 paid registrants in the workshop. If there are less, the workshop will be postponed and all money will be returned. I will not deposit checks until we have the 6 people registered. If you register - please call first as time in limited and I need to have your materials printed asap.

  

Further information:

Connie Sultana at (707) 588-8026 PST, 

conniesultana@sbcglobal.net

  

Make check payable and mail registration to:

Connie Sultana, c/o 39-38 223 Street, Bayside, NY 11361

(requiring a signature upon receipt of the registration may delay its arrival as there is not always someone available to sign for the letter)

Call to let us know you are registering! 707 588-8026.  

 

 

Print and Mail Registration Form (or copy and paste it into a document for printing)

 

Name_____________________________________ ___________________________________

Please print as you want your name to appear on your name tag and certificate

 

Address___________________________________

 

City,State, zip_______________________________________

 

Phone #s_(_____)___________________________

 

  

  

email_____________________________________

 

Profession_________________________________

 

Are you a CBE__, LLLI Leader__, EMT__, trained in... acupuncture__ acupressure__, midwifery__, nursing__, medicine__, massage__, aromatherapy__ other________?

You need not be to attend!

 

# of children__  # vaginal births __  # cesarean births__  # vbacs __ (You need not have given birth to be a doula!)

  

Please include a separate sheet of paper that discusses how you came to be interested in this workshop and your experience with pregnancy and birth. Please tell me what you think I would need to know about your experience. This may be 2 sentences, or as long as your desire.

 

____Intro and Doula Workshop – November 16, 17 and 18 $500 – Register before November 1 and receive $25 discount = $475 for the workshop!  

Registration includes 3 day program, handouts, snacks and certificate of completion for childbirth and doula training.

  

____ Doula Workshop only – November 17 and 18 $400– Register before November 1 and receive $10 discount = $390 for the workshop!   

Registration includes 2 day workshop, handouts, snacks and certificate of completion.

 

____ Intro only – November 16 (circle one): $100

Registration includes 1 day workshop, handouts, snacks and certificate of completion for childbirth education.

  

Your registration in this workshop indicates agreement to all stipulations in this brochure.

 

____I would be interested in talking with you about hosting an out-of-town participant at my home during the workshop.

 

Lunch is on your own. It can be ordered at the workshop or you can bring one.

  

PLEASE PRINT OUT AND MAIL THIS FORM IN WITH YOUR PAYMENT TO RESERVE YOUR SPACE. Call to let us know you are registering! 707 588-8026.

Send to:   

Connie Sultana, c/o 39-38 223 Street, Bayside, NY 11361

 
© 2008 Connie Sultana Doula