This form is divided in to two sections. The area directly below is for information you want shown on the register and will be
viewable by the public.
The bottom half of this form is for our records only and is not viewable by the public.
Your Full Name
Your Email Address
Your Region
....
click the box on the right to select your main region in NZ. If you live near a border you may wish to select more than one area
Click Here To Select Area Below
Auckland
Bay of Plenty
Central Otago
Coastal Otago
Canterbury
Coromandel
Eastland
Fiordland
Hawkes Bay
Lake Taupo
Lake Wanaka
Manawatu - Wanganui
Marlborough
Nelson
Northland
Queenstown
Rotorua
Ruapehu
Southland
Taranaki
Waikato
Wairarapa
Wellington
West Coast
Your Areas within
your region
In the box below type up to 5 places within your region you will travel to as a doula
(eg. towns, cities or suburbs)
.
Your Home Phone
Your Mobile Phone
Your website
(if you have one)
..
http://www.
--------- In the area below, please type the information for our records only ---------
This information
will
not
be viewable by the public and
will not
be given to any other party. If some information is the same as above (Name, Email..etc) retype it below.
Do not
type "
same as above
"
Full Name
Email Address
Home Address
Home Phone
Mobile Phone
USA
UK
Australia
New Zealand
Canada
School of Doula Training
Email or phone of school/course
Year completed course
You must fill out both the top and bottom sections before sending this form
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Standards of Service
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