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Barefoot Doctors’ Academy An Introduction to Midwifery and Doula Certification 2008-2009 Registration Form |
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Please explain your goals for this course: |
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Investment: $925. (Early-bird registration only $850. if paid in full by October 22nd, 2008; Late registration is after January 1st, 2009 and is $975.) Check one: ____ I plan to apply for the Kekumuola Fund for an additional $200. discount & am enclosing the balance of: _____$650. (if submitting before October 23rd, 2008) _____$725. (submitting after October 22nd, 2008. ____ I am a Native Hawaiian, Pacific Islander, Hispanic or adolescent receiving a full scholarship from Malama Perinatal Program. ____ I am an Early-bird, Regular or Late Registrant. Amount Enclosed: ________________________ |
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Donations: If you would care to make a tax-deductible donation or would like to volunteer your services, please call our Director, Dee Anne Domnick @ 808-987-7008, or write to her c/o address listed below. Thank you! |
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Print-out or copy and mail completed registration with payment to: Barefoot Doctors’ Academy; P.O. Box 371; Hawi, HI 96719 Payment must be in the form of a check or money order. Make all checks payable to: Barefoot Doctors’ Academy Register with the BFDA before applying for the Kekumuola Fund. Mahalo! For more information call: 808-987-7008 |
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For office use only: |
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