Copy and paste the following into an email and send to Carla@trustbirth.com.

First Name

Last Name

Date of Birth

Mailing Address

City

State

Zip code

Email

Phone #

Best time to call: AM, PM, Any time

Professional Information:

Midwife Aspiring Midwife Student Midwife Doula Childbirth Educator

Five things you want us to know about you:

Tell us about your experience with birth:

Why are you interested in becoming a leader?

Do you really believe that we can make a significatnt difference with this effort? Yes No I don't know

Are you comfortable with the idea of leading and controlling discussions? Yes No I don't know

Share your ideas for publicizing meetings in your area:

Where do you plan to hold meetings?

Are you in agreement with our vision and goals at this point? Yes No I don't know

Initial here to indicate that you understand that this is a volunteer organization and that we cannot pay you or reimburse expenses.

My feelings on homebirth: (300 words)

My feelings on unassisted birth: (300 words)

Trust Birth meetings are not like childbirth education classes in that: (100 words)

My role as a Trust Birth leader is (or will be) to promote the idea that women should be encouraged to learn what the truth is and base their decisions on truth and not myth or fears. The Truth about Birth IS:

Do you wear the Trust Birth band regularly? Yes No I don't know

Any questions for us?

If you work in the birth field in any way, please attach a resume telling us about your background, education, training and affiliations.