Conference Refund Method Choice- Information Request Form

Conference Refund Payment Information Request-Please complete and return this form prior to December 15, 2022. If submitted after December 15, 2022, there will be a delay in the start of your refund payments.

As previously agreed upon by completing the initial conference refund allocation document, conference refund payments will be sent to you monthly in installments, on or about the 28th of each month, until your conference refund is paid to you in full. If your initial conference refund allocation form was completed prior to November 15, 2022, and this form is completed prior to December 15, 2022, your first refund payment will be sent on or about December 28, 2022. If forms are submitted after these deadlines, monthly refund payments will start approximately 8 weeks after both forms are completed by you and subsequently submitted to IRM. We must receive both completed/signed forms, in order to initiate monthly refund payments.
Conference registration fee that you paid to the International Registry of Midwives. Only your registration fees for the canceled conferences will be refunded:*
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Area/Country CodePhone Number
Please choose an option to receive your refund payments monthly.*

VenmoMoney Order via FedEx/DHL/USPSWorldRemit ( before choosing please ensure WorldRemit cash pickup is available in your country )
If you chose Venmo: please type the username AND phone number associated with your account.
If you chose Money Order by FedEx/DHL/USPS, please provide your full name, phone number and mailing address.
If you chose WorldRemit: please provide your email address, residential address, phone number with country code and full name exactly as it appears on your identification. Pickup information will be emailed to you monthly.
By providing the above information and signing this document, you agree to receive monthly conference refund payments from the International Registry of Midwives, by the method you have chosen, until your refund has been received in full. If you need to change how your monthly conference refund payments are received at a later date, please contact us by email without delay. The email address is: info@internationalmidwife.org*

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Conference Refund Payment Information Request-Please complete and return this form prior to December 15, 2022. If submitted after December 15, 2022, there will be a delay in the start of your refund payments.