Continuing Education Workshop Listing

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

Workshop Approval Code*

Acknowledgements*

I acknowledge that I checked the DONA International website for workshop listing(s) and communicated with any trainers hosting a workshop in close proximity of time and distance to my proposed workshop, to inform and connect with the aforementioned trainer.

I further acknowledge that I am not required to gain permission from a trainer hosting a training in close proximity of time and distance with my own proposed training.

I acknowledge that my roster will be submitted 24hrs before the start of my workshop to dona.org/trainerroster/ and within two weeks of the completion of the workshop.

I further acknowledge that my evaluation will be sent directly to my workshop participants at least twice within one (1) week after the completion of the workshop from either dona.org/birthworkshopeval or dona.org/postpartumworkshopeval.

Contact First & Last Name

Contact Phone Number

Your City/State or City/Providence*

Contact Email

Website

Workshop Details

Name of Continuing Education Workshop*

Public/Private*

If you choose Public you will be directed to the PayPal payment page after you click submit.

Location of Continuing Education Workshop*

Type of Continuing Education Workshop*

Dates of Continuing Education Workshop*

Include Month days, and year Ex: February 4 - 5, 2022

Special Content/Population Description:

Examples: “For Healthcare Professionals – 18 Nursing CEUs” OR “Workshop focused on Black community support”.

Location Type for Workshop*

Payment Submission

Total

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

DONA International has a no-refund policy. All transactions are subject to PayPal policies.