09 PfB payment plan agreement

Lamaze scholarship application

Location	Event	Payment
Louisville, KY   Feb. - March     This workshop will meet weekly instead of the typical three day format. For more information, contact Robin	Passion for Birth Ongoing seminar Trainer: Robin Weiss	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Atlanta area, GA   Feb. 10 - 12 2010	Passion for Birth 3 day seminar Trainer: Teri Shilling Host: Alice Turner   Register/pay by Jan. 10 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Mobile, AL   Feb. 13 - 15 2010	Passion for Birth 3 day seminar Trainer: Teri Shilling Host: Ashley Love   Register/pay by Jan. 12 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Santa Rosa, CA   Feb. 26 - 28 2010	Passion for Birth 3 day seminar Trainers: Connie Sultana Teri Shilling (if adequate registration) Host: Connie Sultana   Register/pay by Jan. 26 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Edmonton, AB CANADA   March 19 - 21 2010	Passion for Birth 3 day workshop Trainer: Sharon Dalrymple Host: Christine Richardson   Register/pay by Feb. 19 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
New Delhi, INDIA   March TBA 2010	Passion for Birth 3 day seminar Trainer: Shruti Saxena	Option 1: Cost : Rs 18000 for seminar and Lamaze I. study guide/membership Order Study Guide here and send cheque to  Triple Goddess for R11500 for seminar.  Option 2: Seminar only.  Pay Rs 11500 via cheque to Triple Goddess Fitness . Purchase study guide/membership later.   Both options: Complete registration form below.   send Shruti a message now to arrange for seminar payment. Lamaze I. Study Guide ($130) non-refundable Want to become Lamaze certified?  This includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal
Lincoln,NE   April 14 - 16 2010   NOTE: THIS WORKSHOP WILL BE AVAILABLE INTERNATIONALLY VIA THE INTERNET. Contact Teri for more details - but this will be "live" - you have to have internet access/webcam for 8 am to 5 pm CENTRAL US Time.)	Passion for Birth 3 day seminar Trainers: Teri Shilling Jan Madsen Host: Jan Madsen St. Elizabeth's Health Care System   Register/pay by March 14 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395 - in-person): Seminar registration - international.  Will participate via live internet.  Must download and print own workshop manual.  $240 Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Seattle, WA   April 26 - 28 2010	Passion for Birth 3 day workshop Trainers: Teri Shilling Sharon Muza Host: TBA   Register/pay by March 26 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
New York City, NY   May 2 - 4 2010	Passion for Birth 3 day workshop Trainer: Teri Shilling Host: Rina Crane   Register/pay by April 2 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Topsail Beach North Carolina   May 20 -23 * 2010   * schedule is changed to allow beach time!	Passion for Birth 4 day seminar Trainer: Ann Tumblin (and Teri if enough registrations) Host:  Ann Tumblin   Register/pay by April 20 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Albuquerque, NM DONA Conference     August 4 - 8	Passion for Birth 2 day DONA pre-conference Trainer: Ann TUmblin Host:  DONA International	DONA International is handling the registration for this pre-conference.  Registration does NOT include the Study packet. You must attend the DONA conference and the pre-conference seminar.    PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
High River, AB Canada   Nov. 12 - 14	Passion for Birth 3 day workshop Trainer: Sharon Dalrymple Host:  Sharon Dalrymple   Register/pay by Oct. 12 to receive a complimentary copy of The Idea Box for the Creative and Interactive Childbirth Educator!	Once you have paid for the seminar, please complete the registration form at the bottom of this page!     Seminar registration ($395): Deposit ($100) Can't afford to pay for the enitre seminar fee?  Make a deposit to hold your spot in this seminar. Deposit is non-refundable.   PfB study packet ($180) non-refundable Want to become Lamaze certified?  This packet includes:  Lamaze Study guide Lamaze student on-line membership access to the PfB Learning Task Journal copy of the Official Lamaze Guide - Birth with Confidence book a PfB goodie bag!
Monterrey, Mexico   To be re-scheduled	Passion for Birth 3 day seminar Trainers: Teri Shilling Teresa Navarro Host: Centro Mae and Cendis	This seminar is being sponsored and registration is limited and being handled by the sponsor.  Email teri@passionforbirth.com for more information.

OTHER FEES  Note: fees for the Lamaze certification exam are additional and paid directly to Lamaze.
Study Packet	$180 PfB study packet  This packet includes your on-line Lamaze Study Guide, on-line Lamaze membership, PfB Learning Task Journal access, copy of the Lamaze Official Guide - Birth With Confidence book and a PfB goodie bag.  Get started today. Non-refundable.
Review/feedback on your course design (optional but recommended)	$75  Includes "Putting Together Your Course Design booklet" and review of course design and return postage.
LCCE (Lamaze Certified Childbirth Educator)	$195 for seminar (and contribution of snacks for the group - yum!) Your role will be as a resource for new educators.  You will receive 20 Lamaze and nursing contact hours you can use towards your recertification.We limit the number of LCCEs per seminar, so before registering, check with Teri to see if the seminar you want has room for a LCCE.
Host	Seminar fee waived per 8 - 10 paid seminar attendees (if less than 8 pay, PfB will negotiate with host for possible lodging for trainer and/or providing food/beverages for the seminar in lieu of registration)  The Study Packet fees are NOT waived for the host. Email us for information on hosting a seminar
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Ready to get started?  Sign up here: (if registering for just the seminar, only the boxes with the * are required)
*Location of seminar: (if unsure, write unsure)
*Date of seminar:
*How will you pay?	Credit card through paypal Credit card through Google accts. Check sent to PfB Purchase order Payment plan info. needed Received scholarship from Lamaze
*Contact information:
*First name:
*Last name:
*Email address:
*Company:
*Mailing address:
*Easiest phone number to reach you: *Do you receive text messages at this #?	Yes No
*AIM NAME for IM
*Best way to contact you:	Email address Phone number Mailing address AIM IM FACEBOOK
*Are you on Facebook?
*Additional information:
*Which pathway are you on?	New/traditional path Experienced/open path Midwife/midwifery student Seminar only unsure/confused
*What are you top 3 favorite ways to learn?	Demonstration/Return Demonstration Discussion Lecture/Powerpoint Reading/Researching Roleplay Small group tasks Watching DVDs
Briefly describe your experience in birth and/or teaching: Why are you coming to a PfB seminar? Names and email addresses for two people who we can contact as references to say you would be a great childbirth educator.

It's our preference that you complete the enrollment form on line but if you need a hard copy to complete, a word document with the same questions is downloadable here:

click here to Word PfB application file