South Florida Midwifery Education Collective Presents ....Midwifery Assistant Training
Training dates:
(All Sundays)
March 5, 12, 19, 26
April 2, 9, 23, 30

Time: 1:00-6:00pm

Location:
Power U Center for Social Change
745 NW 54th St
Miami, FL 33127 (entrance on 55th St)

Cost: $600-800 sliding scale
(pay what you can afford within the range)
Make payment via PayPal to southernbirthjustice@gmail.com
Contact: Jamarah at 786-503-1002 with questions

*The information in this application is confidential and will be protected. We ask these questions in the interest of inclusion and because of our commitment to equal rights for all students.*

Email address *
Name *
Full name
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Phone number *
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Home Address *
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Mailing Address (leave blank if same as above)
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Date of Birth *
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Social Security Number
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Immigration Status
Relationship Status
Ages of children, if any
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Sexual/Romantic orientation - select one or other
Race - select all that apply or other
Gender - select all that apply or other
Socio-economic status - select all that apply or other
Primary language *
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Other languages
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Emergency contact and phone number *
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Education Level - select one *
Certifications - select all that apply or other *
Required
Birth Experience: Please briefly describe any birth related experience, including previous midwifery work, assisting midwives, doula work or personal birth experiences. *
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