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End-of-Life Doula Membership Form
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Yearly
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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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This will be the one used in the doula directory
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If applicable, this will be the used in the doula directory. Example: specific county served
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This is the email that will be put in the website directory (if you wish to be listed)
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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
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Please check your top 3-5 reasons
Please check all that apply
Please check all that apply
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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.
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NEDA sends out a monthly newsletter as well as webinar announcements to members only. You always have the option to unsubscribe to the emails at any time.
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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)."