The International Center for Traditional Childbearing
THE INTERNATIONAL CENTER FOR TRADITIONAL CHILDBEARING



THE INTERNATIONAL CENTER FOR TRADITIONAL CHILDBEARING
SOUTH EAST BLACK MIDWIVES AND
HEALERS SUMMIT:
REDUCING MATERNAL AND INFANT MORTALITY BY
 BUILDING COMMUNITY LEADERSHIP
SE Summit Registration

First Name:
Last Name:
Name for Badge:
Organization/School:
Mailing Address:
City:
State:
Zip Code
Phone: (xxx) xxx-xxxx
E-mail:
Meal Option 1: Regular
Meal Option 2: Vegetarian 
 Meal Option 3: Vegan
   
Pre-Summit:  EARLY BIRD
October 13, 2011 1-4PM		 Pre-Summit:  EARLY BIRD
October 13, 2011 1-4PM
How to Become a Midwife  $38(M) $40(NM) $36(S)
Midwifery Clinical  $38(M) $40(NM) $36(S)
Summit: EARLY BIRD
October 14-16, 2011		 Summit: EARLY BIRD
October 14-16, 2011
Full Summit (Fri,Sat,Sun) $261(M) $275(NM) $247(S)
 Friday Summit Only $133(M) $140(NM) $126(S)
 Saturday Summit Only $133(M) $140(NM) $126(S)
 CEU'S $30(M) $30(NM) $30(S)
Scholarship Donation (Amount)
TOTAL ENCLOSED:
 
PRE-SUMMIT
After September 25, 2011

 PRE-SUMMIT
After September 25, 2011 
 How to Become a Midwife $42(M) $45(NM) $40(S)
Midwifery Clinical  $42(M) $45(NM) $40(S)
SUMMIT 
After September 25, 2011 		 SUMMIT
After September 25, 2011
Full Summit (Fri, Sat, Sun)  $285(M) $300(NM) $270(S)
Friday Summit Only  $142(M) $150(NM) $135(S)
Saturday Summit Only  $142(M) $150(NM) $135(S)
 CEU's $30(M) $30(NM) $30(S)
Scholarship Donation:
TOTAL ENCLOSED:


Thank you!
PLEASE PAY USING PAYPAL 

FOR DETAILS AND ACCOMMODATIONS: CLICK HERE


The International Center for Traditional Childbearing
P.O Box 11923
Portland, OR 97211
503-460-9324
ICTC@ICTCMIDWIVES.ORG
WWW.ICTCMIDWIVES.ORG









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