Midwifing Change

Midwifing Change

Welcome! We’re excited that you’re joining us for the Midwifing Change Summit. Organizing this gathering has been an act of vision and a labor of love, and we’re so grateful to have you with us.
Name*

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Email*
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Organization / Community
Where did you hear about the summit?
What are some ways that you are Midwifing Change in your life, community or work? Feel free to write as little or as much as you want.
Would you like to be notified about upcoming Bloom offerings?*

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Contribution
This gathering is offered in the spirit of gift culture and reciprocity. The Bloom team, graphic designers, speakers, facilitators, and contributors have gifted their time, energy, and many forms of capital - relational, cultural, creative, and financial - to support this meaningful convergence.

You are warmly invited to contribute what you choose. As a guide, the suggested minimum is the cost of two nice meals in your area. If the low end of the scale still represents a financial barrier, feel free to pay what you choose - even $0.

No one will be turned away for lack of funds.
Sliding Scale Options (All amounts in CAD)*

Option A - $25Option B - $50Option C - $100Option D - $300Option E - $500Option F - Pay What You Choose
Pay What You Choose
Total
Consider contributing MORE on the scale if you:
- Comfortably meet your basic needs
- Belong to a sponsoring organization or have full-time employment
- Have investments, retirement funds, or inherited wealth
- Travel recreationally
- Have access to family resources
- Work part-time by choice
- Own your home
- Benefit from social or economic privilege (e.g. education, race, gender, class)
Consider contributing LESS on the scale if you:
- Struggle to meet basic expenses
- Support dependents
- Have significant debt or uncovered medical costs
- Are an elder with limited financial support
- Are an unpaid community organizer
- Experience housing instability or unreliable transportation
- Cannot afford time off due to financial constraints
(Inspired by the “Green Bottle” sliding scale model by Alexis J. Cunningfolk | www.wortsandcunning.com)

If you choose an amount at the higher end, you help make this and future gatherings possible, supporting the generous gifts of all involved.

Payment Amount

CADDescription

Credit Card Details*
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

*If paying by credit card isn’t possible for you, please don’t let that be a barrier. Reach out to us at info@bloomworld.org, and we’ll be glad to explore other payment options together.
Thank You & Next Steps

Thank you for joining the Midwifing Change Summit! We hope this gathering will be a space where you can rest, connect, share your work, learn new skills, and discover unexpected inspiration.

Your contribution makes this summit possible and helps us continue creating spaces for reflection, learning, and community. If you weren’t able to contribute financially, please know that your presence and participation are deeply valued. Thank you for being with us.

After submitting this form, you will receive an automated email with more information about the summit and important links. If it doesn’t appear in your inbox, please check your spam folder.

With gratitude,
Rehana, Moyo & the Bloom Team

P.S. If you have any questions or need support along the way, feel free to reach out to Dan at info@bloomworld.org.
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