Speed Dating Registration
Welcome to the #EFB2017 speed dating registration form! We are so excited to have you on board!
Please be as complete as possible in this section. We will use it as we promote you in the months before the event.
Business Name (if applicable)
Facebook and Other Social Media Links (enter links to everywhere you can be found!)
What is your specialty? What sets you apart from other providers? (VBAC-friendly? Waterbirths? Family centered c-section?)
Are you a:
Midwife (LDEM or similar)
Geographical Areas Served (Pick up to 3)
Salt Lake County
Please take a moment to email your logo file to
. The higher quality the better.
I emailed it! I want the logo to look great on all your promotion efforts for me!
Please take it from my website. A low quality version is fine.
Giveaway Product or Package (Optional)
I agree to the participant expectations.
After you click SUBMIT below, you'll be taken to PAYPAL to complete your payment. Please note that your space is NOT reserved until payment is received. Please email us if you have questions.
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