MBCP Teacher Website Page Entry

MBCP Teacher Website Page Entry
Will this be a new entry to the website or amendment?*

New RecordAmendment
For entries that are amendments, you only need to complete the fields in the form below that you would like amended on the website. If you have any questions, please email mbcptt@mindfulbirthing.org.
Name*

First NameLast Name
Email*
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you actively teaching?

YesNo
Do you plan on teaching again and if so when?
Where are you teaching?

OnlineIn-personOnline and In-Person
Are you teaching MBCP / MBCPI (formerly Mind in Labor)/MBEP (select all that apply)?

MBCPMBCPIMBEP
Do you have a website?

YesNo
Please provide your website URL
Do you have a Facebook page?

YesNo
Please provide a link to your Facebook page
Do you have an Instagram page?

YesNo
Please provide a link to your Instagram page
Which languages are you teaching in?

ChineseEnglishFrenchGermanArabicDutchHebrewHungarianIndonesianJapaneseLatvianPolishPortugueseRussianSpanishTurkishOther
Would you like to be listed on our website?

YesNo
Would you like to provide an updated photo for the website?

YesNo
Please provide a headshot / photo that can be used on the website

Cancelof
Should be Empty: