Registration Form | TIC for Birthworkers

First Name

Last Name

Email

Please tell us what you will pay. Sliding scale of $100-$250. (Registration must be paid to reserve your space. You will receive an email confirmation & may pay by Venmo, check, or cash.)

Do you need to add CEU fees? $25 (ACNM specialty credit has been applied for)

Yes

No

Anything we should know?

To register, please complete the following:

TIC for Birthworkers in Arizona