National End of Life Doula Alliance · End-of-Life Doula / Trainer Membership Form

Annual Membership Fee

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$100

Your credit card will be renewed automatically on your sign-up date to ensure your membership for the next year.

Name

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First Name

Last Name

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

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This will be the one used in the doula and trainer directories

Name of Your EOL Doula Training Business

Email

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This will be the one used in the doula and trainer directories

Website, beginning with http://www.

Gender

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Age Range

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Race / Ethnicity

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Check all that apply

Caucasian

African American /Black

Latinx

Native American

Asian

Bi-Racial

Multi-Racial

Other

Prefer not to answer

Education Level

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Teaching Specialty

Details of the End of Life Doula Training Program You Offer to Others and Your Credentials

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Please describe the doula training program you offer other doulas (max of 350 characters) and list your credentials to be included in your directory listing.

Number of Years Teaching Doula Training

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Household Income

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Percentage of Income From Doula-related Work

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Payment Structure

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Check all that apply

Services provided at no charge

Donation determined by client

Fee for service

Sliding scale

Barter

Services paid by umbrella organization

Volunteer within community organization

Volunteer within Hospice

Other

I am joining NEDA because:

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Please check top five reasons

I have worked in a profession closely associated with EOLD and want to see it grow

I have benefited from doula services in the past

To learn more about the field of end of life doulas

To access written/published resources and online education, such as webinars

To become NEDA Proficient

To get referrals from prospective clients because of being listed in the NEDA online directory

To network with other EOLDs and professionals in the field

Being NEDA member lends credibility to my work

To have access to the social media closed EOLD groups (such as the NEDA Member Facebook page)

I would like to be involved with NEDA as a volunteer:

Please check all that apply

I have interpersonal/leadership skills

I have organizational skills

I have media/publicity skills

I have writing skills

I have public speaking skills

I have technological skills (i.e., website or database maintenance, etc.)

I have networking skills (building bridges with individuals and other orgs.)

I have fundraising/development skills

I have administrative skills

Upload Head Shot Photo

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Please use a professional head shot, if possible

End-of-Life Doula Directories

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I acknowledge that by agreeing to have my contact information listed on the NEDA Online Directory I may be contacted by individuals, companies, or groups not associated with NEDA. My contact information will be public and cannot be controlled by NEDA.

I want to be included in the End-of-Life Doula website Directory only

I want to be included in the End-of-Life Doula Trainer website Directory only

I want to be included in BOTH Directories on the website

I do not want to be included in a Directory on the website

NEDA Regional Group Contact Sharing

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Yes, I give permission to share my email address with other NEDA members interested in forming regional groups

No, I do not give permission to share my email address with other NEDA members interested in forming regional groups

Directory Agreement

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"By clicking the box below, I am indicating that I understand and accept the following terms: 1) Inclusion of my information on the website directory does not constitute endorsement by NEDA or my training organization, if I have one. 2) I am fully responsible for my own contracts, promotion, and interaction with the public. 3) I have read and agree to honor the NEDA Code of Ethics, Conduct, and Scope of Practice. 4) I understand that my listing on the website directory will only be included as long as I am an active member of NEDA (renew each year)."

Yes, I agree