Practicing African American Postpartum Care – Register Now!

Practicing African American Postpartum Care Registration Form

March Training: March 15, 2023. 10:00 am PT- 5:30 pm PT.

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Complete this form and submit along with payment to register for "

Practicing African American Postpartum Care(PAAPPC)

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Training Information

Complete this form and submit along with payment to register for "Practicing African American Postpartum Care".

Select Your Training*

Registration for your selected training opens on August 1, 2023.".

How did you hear about us?*

Contact Information

First Name (Legal)*

Last Name (Legal)*

Credentials

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone Number*

Primary E-Mail Address*

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Ethnicity

Education Level*

Billing Information

The billing address associated with your or your Authorized Payer debit or credit card used when processing payment for your training tuition and fees.

First, Last Name (Authorized Payer)*

First Last

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone Number (Authorized Payer)*

Primary Email (Authorized Payer)*

Is your mailing address the same as your billing address?*

If you are the authorized payer and your "First Name, Last Name and Mailing Address" is the same as your "Billing Address", select "Yes."

Photo and Media Release

Photo and Media Release

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration; I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears; waive any right to royalties or other compensation arising or related to the use of my image or recording.

I understand that I may be consulted about the use of the photographs or video recording for any purpose other than those listed above; that there is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. I understand this release applies to photographic, audio and/or video recordings collected as part of the sessions listed on this document only and by signing this form, I acknowledge that I have completely read and fully understand the aforementioned and agree to be bound thereby.

I understand that photographic, audio and/or video recordings may be used for the following purposes: conference presentations, educational presentations or courses, informational presentations, on-line educational courses and educational videos.

I understand that I will be consulted about the use of the photographs or video recording for any purpose other than those listed above and that there is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. I understand that this release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

Agreement*

I have completely read and fully understand the Photo and Media Release and agree to be bound thereby.

Cancellation and Refund Policy

Cancelation and Refund Policy

If the training is canceled by SMC, the registrant (trainee) will receive a full refund.
If the registrant (trainee) cancels within 24 hours from the time of registration, a refund will be given, less administrative fee of $50.00.
If the registrant (trainee) cancels at least two weeks prior to the training start date, the registrant (trainee) has the option of transferring to another training of equal or lesser value within the program within 12 months of the original training date.

Confirmation of Understanding*

I have completely read and fully understand the Cancellation and Refund Policy and agree to be bound thereby.

Payment Options

Payment Option 1- Single Payment

Pay for your training in one easy payment. You will receive your provisional doula certificate on the last training day. Registration fees must be paid in full prior to the training start date.

Today You Pay:$750

Payment Option 2- Two Installments

Pay for your training in two easy payments. You will receive your provisional doula certificate on the last training day. Registration fees must be paid in full prior to the training start date.

Today You Pay: $375.00

Select A Payment Option*

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Practicing African American Postpartum Care – Register Now!

Practicing African American Postpartum Care Registration Form

Practicing African American Postpartum Care Registration Form

Practicing African American Postpartum Care(PAAPPC)

Create Your Account

Training Information

Contact Information

Billing Information

Photo and Media Release

Cancellation and Refund Policy

Payment Options

Payment Option 1- Single Payment

Payment Option 2- Two Installments

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