Doula Member Registration Form

Red Deer Doula Association

NEW MEMBERSHIP APPLICATION INFORMATION
Full name *

First Name Last Name
Name as it appears on Facebook *if different than above

First Name Last Name
Business name

Mailing address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone number *

Area Code Phone Number
E-mail *
Website
Facebook page link
Instagram page link
Please upload your logo
I am applying as: *

Active level membership $75 yearly Associate level membership $50 yearly
I am applying as *check all applicable: *

Birth doula Postpartum doula Bereavement doula
When did you start working as a professional doula?
How many families have you served as a Birth and or Postpartum doula?
What cities/areas do you serve? *
Please list all your trainings, certificates, conventions attended, and skills that you have to offer our community Please include the date you attended or completed. *
Please upload Completion of Training and Certification documents

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What are your current fees you charge for your services? *
Are you willing to serve those with special situations and financial limitations? *

Yes No
Associate level of membership- Please provide a short bio about yourself, your interests, why you are interested in doula work, and anything unique you'd like to share.
Active level of membership- Please provide a detailed biography of you and your business. For an idea- please browse our current active members' bios on our website. Copy and paste URL into your browser http://www.reddeerdoulaassociation.com/meet-our-doulas/

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Please upload a current headshot image
As part of this membership I have reviewed and agree to the following documents pertaining to the RDDA:
General Guidelines
I give permisission to the RDDA to post information and photos of me and my business
*optional
RDDA Public Social Media Platforms *
RDDA Private Facebook groups *
RDDA Public Website *
The following supporting documentation needs to be submitted within this application or emailed to RddaDoulas@gmail.com

Please give reference of any two people whom you feel would be able to provide a positive professional or character reference on your behalf:

Full Name

Address

Contact Number

How did you hear about the Red Deer Doula Association? Please check all that apply.

Social Media Internet Search Family or Friends Prenatal Care Providers Wellness Practitioner Current or past RDDA member
If a person or business referred you to the Red Deer Doula Association, who can we thank for the referral?
Please send membship fee at the same time as submitting your membership application. Cash and Email Money Transfers accepted by Membership Coordinator/Treasurer at:
rddadoulas@gmail.com
Password: Association
Application Fees due October 1st each year. Society year runs from October 1st-September 30th.
Active Level- $75 / year
Associate Level- $50 / year
By completing, signing and submitting this application, I state that I have read, agree, and submitted all necessary documents:

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Red Deer Doula Association