Venue: Date: - Nurturing Birth

Venue:
Date:
REGISTRATION IS ON A FIRST COME FIRST SERVED BASIS
Doula Course Booking Form
Participant Information
Title
Full Name:
Address:
City
Post Code
Mobile:
Country
Email:
Home:
Website:
Business name:
NO
YES
Age:
Children:
YES
NO
Have you used the services of a Doula?
If Yes Please give details:
Experience
Current Occupation:
Any Qualifications
in relations to the
following:
YES
NO
YES
NO
YES
NO
YES
NO
*Antenatal Preparations:
*Birth:
*Post Natal:
*Infant Feeding:
Which?
Date
Which?
Date
Which?
Date
Which?
Date
Other:
www.nurturingbirth.co.uk
Nurturing Birth Limited, 108 Shenstone Valley Road, Halesowen, West Midlands, B62 9TF, UK
0121 422 2819
How did you hear about the course?
Web Search (yahoo, Google…) Or From Doula UK:
YES
NO
Date:
Did you attend the DUK introduction to the work of a doula day?
Name (optional):
Personal Recommendation:
Payment
PAYMENT: Please read carefully
The Birth and Postnatal course is £450. A minimum deposit of £150 is required with the
application form in order to guarantee your place on the course.
Payment is by bank transfer to:
Nurturing Birth Ltd, HSBC bank
Sort code: 40-44-37
Account number: 32064286
Reference – your surname (as given on the booking form) and venue.
OR
Cheque payable to:
Nurturing Birth Ltd
Reference on the back of the cheque – your surname (as given on the booking form) and venue.
Payment (cheque or proof of online payment) must be enclosed for the application form to be
valid. The fee includes a comprehensive manual, access to a mentor, access to our on-line forum
(reserved for our NB trained doulas), a quarterly e-news and a free place for 6months+ on our on-line
Doula Directory.
Payment Plans are only available by previous arrangements with Nurturing Birth. Please
contact the office by email ar [email protected] or call on 01214222819.
PLEASE READ CAREFULLY. As per Trading Standards guidelines, payment is only refundable up to 7
days after receipt of your payment. Should you suddenly be unable to attend the course you have
booked (due to unforeseen circumstances) you can postpone once but you will not be entitled to a
refund. We reserve the right to postpone and/or change the venue location. We will offer an alternative
where possible.
Signature
Signature:
Date:
Office Use Only
Initial Payment: £
P C Module:
Method:
Date sent:
YES
Payment Plan
Date:
Date received
Booked with Friend:
NO
Proposed Dates:
Amount:
Date received
www.nurturingbirth.co.uk
Nurturing Birth Limited, 108 Shenstone Valley Road, Halesowen, West Midlands, B62 9TF, UK
0122 422 2819
Why Would You Like To Become a Doula
Please spend a few minutes reflecting on the above question and let us know in a few lines:
www.nurturingbirth.co.uk
Nurturing Birth Limited, 108 Shenstone Valley Road, Halesowen, West Midlands, B62 9TF, UK
0123 422 2819

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