Emberlight Experiential Learning Interest Form
Emberlight training programs incorporate a loving way of embracing death to experience the fullness of life. Grounded in community-centered care, loving presence, humble service, and a deep willingness to be with death’s mystery, vulnerability, and intimacy, the program weaves together knowledge and skills, ritual, music, creative expression, embodied practice, and the healing power of gathering together.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Zip Code
How did you first hear about the Emberlight Community? (Select all that apply)
Internet search / Website
Friends and Family
Film - The Last Ecstatic Days
Word of mouth
Social Media
Podcasts
TEDx Talk by Aditi Sethi
Other
Which offerings are you interested in? (Select all that apply)
Community Death Doula Certificate Program - Eight online learning sessions and three day Retreat onsite at Emberlight
Community Death Doula Apprenticeship - Five days onsite at Emberlight, including hands-on skills training and bedside service experience
Full Program: Community Death Doula Certificate Program + Community Death Doula Apprenticeship
Standalone Workshops Online
Standalone Workshops Onsite at Emberlight
Retreats / Immersive Experiences
Other
What is your level of interest/availability?
Interested in participating late 2026
Interested in participating sometime in 2027
Interested, but timing uncertain
Not interested at this time
Not interested at all
What is your level of interest/availability?
Interested in participating now
Interested in participating later this year
Interested in participating sometime next year
Interested, but timing uncertain
What is your level of interest/availability?
Interested in participating now
Interested in participating later this year
Interested in participating sometime next year
Interested, but timing uncertain
How do you want to use your training? (Select all that apply)
Building your own Doula Business
Caring for a loved one in their home
Working in a hospice
Working with a Doula Collective
Personal transformation/growth
Create Local Emberlight Chapter
Other
What most draws you to the offerings? (Select all that apply)
Bedside care and practical skills training
Community learning and connection
Retreat / immersive experience
Exploring death, dying, and end-of-life care
Personal growth / inner development
Connecting to the Emberlight Community
Other
Is there anything else you’d like to share?
Submit
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