One moment please...
End-of-Life Doula Trainer Membership Form
*
Yearly
*

First Name
Last Name
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
*

This will be the one used in the trainer directory
*

*

This will be the one used in the trainer directory

*
*
*
Check all that apply
*
*
Click all that apply
*
*

Please list the percentage of your household income that comes from your doula work.
*


Please describe the training program you offer to other doulas (max of 350 characters) and list your credentials to be included in your directory listing.
*
Please check top five
Please check all that apply
*
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.
*
*

Please use professional head shot, if possible.
*
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).