Membership Application

THBS Collective Application

Independent Contractor Application
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
What organization have you trained with? *
When did you begin your training? *
Did your training include a workshop or series of live training sessions? *

Yes No Not attended yet
Are you certified? *

Yes No Not renewed
When do you plan on completing your certification? *
What other training and/or certifications do you have? *
How many births have you attended? *
How many do you plan on attending in the next 12 months? *
Why do you want to join the THBS team? *
Where are you located/what geographic areas do you serve? *
What are your fees for services? *
Are you willing to back up another THBS doula? *

Yes No
What is your greatest challange as a birthworker? *
Is there anything else you would like us to know? *
After submission, please allow at least a week for a reply.
Should be Empty:

THBS Collective Application