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End-of-Life Doula Membership Form
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Annually
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First Name
Last Name

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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Check all that apply
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Please list the percentage of your household income that comes from your doula work
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Check all that apply
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Check all that apply
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Please check all that apply
Please check all that apply
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Please use a professional head shot, if possible.
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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)."