Midwifery Today Conference
“The Heart and Science of Birth”
Eugene, Oregon • April 5–9, 2017
Registration Form

There’s still time to save! Register by February 6, 2017

1. Name and Address

Please print.

First Name
Last Name
Name to appear on badge (if different)
Street Address / P.O. Box
City
State / Province
ZIP / Postal Code
Country
Telephone
Fax
E-mail Address

Certification number (if applying for CEUs) _____________________________________

How are you involved in birth?

  •  Direct entry midwife
  •  Licensed midwife
  •  Certified nurse-midwife
  •  Student midwife
  •  Aspiring midwife
  •  CPM
  •  RN
  •  Naturopath
  •  Childbirth educator
  •  Doula / LA
  •  Midwife educator
  •  Other _____________________________________

How many births have you attended? _________

How did you hear about this conference?
What excites you about this conference?

Do you give permission for Midwifery Today to release your name and address to fellow registrants?

  •  Yes
  •  No

2. Class Selection

Please check off each day of the conference you plan to attend.

  •  Wednesday, April 5, 2017: Pre-Conference
  •  Thursday, April 6, 2017: Pre-Conference
  •  Friday, April 7, 2017: Conference
  •  Saturday, April 8, 2017: Conference
  •  Sunday, April 9, 2017: Conference

Please check off each class you will attend. Select one class from each set of concurrent sessions offered on the days you will attend. For example, if you will attend the conference on Friday, you need to select one class from C1 through C4 and also one class from D1 through D4. Class descriptions can be found in the conference program.

Wednesday, April 5, 2017: Pre-Conference

Select a full-day course (9:00 am – 5:00 pm):

  •  A1
  •  A2
  •  A3
  •  A4

Thursday, April 6, 2017: Pre-Conference

Select a full-day course (9:00 am – 5:00 pm):

  •  B1
  •  B2
  •  B3
  •  B4

Friday, April 7, 2017: Conference Day One

Select one class (2:30 pm – 4:00 pm):

  •  C1
  •  C2
  •  C3
  •  C4

Select one class (4:15 pm – 5:45 pm):

  •  D1
  •  D2
  •  D3
  •  D4

Saturday, April 8, 2017: Conference Day Two

Select one class (1:30 pm – 3:00 pm):

  •  E1
  •  E2
  •  E3
  •  E4

Select one class (3:30 pm – 5:00 pm):

  •  F1
  •  F2
  •  F3
  •  F4

Sunday, April 9, 2017: Conference Day Three

Select one class (10:30 am – 12:00 pm):

  •  G1
  •  G2
  •  G3
  •  G4

Select one class (1:30 pm – 3:30 pm):

  •  H1
  •  H2
  •  H3
  •  H4

3. Subscribe to Midwifery Today  [ Optional ]

Subscribe to Midwifery Today magazine and save up to $75 on conference prices! Subscribers to Midwifery Today are eligible for reduced conference prices. If you are not currently a subscriber, you can obtain registration discounts by subscribing at this time. Midwifery Today magazine is published four times per year. Each issue contains articles, stories, and opinions, written by midwives and other birth practitioners from around the world.

AddressPrice for 1-year subscription to Midwifery Today
United StatesU.S. $55
CanadaU.S. $68
InternationalU.S. $75

If you would like to subscribe to Midwifery Today, please select the appropriate box below and enter your subscription price in the Payment section of this form.

  •  Please begin my subscription.
  •  Please renew my subscription.
  •  I am already a subscriber.

4. How to Determine Conference Prices and CEU Fees

  1. Prices do not include transportation, overnight accommodations or meals. Look up the price in the table in Section 5, Conference Prices and Payment.

  2. Discounts

    Note that the table shows discounted prices for those who register early and for those who are subscribers to Midwifery Today.

    Tuition-paying students who register for three or more days may deduct 30% when they submit, with their registration, proof of their full-time student status. [The student discount does not apply to subscriptions, CEUs or lunch.] Enter the prices that apply to you on the lines provided in the payment section of this form.

    No discounts apply to subscriptions, CEUs or lunch.

  3. Please pay your CEU fees at this time: $10 per day for ACNM, MEAC and OBNM.

    Please check the boxes below for the CEUs you are requesting, and enter your total CEU fees in the Payment section of this form. Each day of the conference, including pre-conference and post-conference, is charged as a separate day.

    •  ACNM
    •  MEAC
    •  OBNM
  4. Please mail this form with your payment in U.S. funds to Midwifery Today. If you pay by credit card, you may fax this form to Midwifery Today or call the office to register. You may register by e-mail, but do NOT send credit card details by e-mail. Use the Contact Addresses and Telephone Numbers at the bottom of this page. Go here to register online.

5. Conference Prices and Payment

Register Early and Save up to $90! By registering early you become eligible for reduced conference prices. You can receive an additional discount of up to $75 by subscribing to Midwifery Today magazine. The early registration deadlines are December 2, 2016, and February 6, 2017. Registrations must be received in office at Midwifery Today no later than March 22, 2017. If you cannot mail your registration early enough for it to be received on or before March 22, 2017, please register at the conference.

* No discounts apply to subscriptions, CEUs or lunch.

Attendance Postmark on or before
December 2, 2016
SubscriberNon-Subscriber
1 dayUS $130US $145
2 daysUS $260US $290
3 daysUS $335US $380
4 daysUS $455US $515
5 daysUS $575US $650
Attendance Postmark on or before
February 6, 2017
SubscriberNon-Subscriber
1 dayUS $140US $155
2 daysUS $280US $310
3 daysUS $360US $405
4 daysUS $490US $550
5 daysUS $620US $695
Attendance Postmark on or before
March 22, 2017
SubscriberNon-Subscriber
1 dayUS $150US $165
2 daysUS $300US $330
3 daysUS $385US $430
4 daysUS $525US $585
5 daysUS $665US $740

Register by mail, phone, fax or e-mail: The prices you pay are determined by the postmark on the envelope in which you return your registration form. If you register by telephone, fax, or e-mail, the date Midwifery Today receives your communication will be deemed to be the postmark date.

After March 22, 2017, registrations are only accepted in person at the conference. If you cannot mail your registration early enough for it to be received by this deadline, you may register at the conference. Simply pay the March 22, 2017, prices when you arrive at the conference. For easy registration, print this form using the Print This Page link at the top, fill it out and bring the form, proof of full-time student status if applicable, and your payment to the registration desk at the conference. Class offerings may be limited, so please contact Midwifery Today before you arrive.

Please calculate the amount you need to pay by completing the items below.

Enter your conference price from the table above. 
*If you qualify for the student discount (see the Discounts section above), enter the amount of your discount (multiply the amount on the first line by 30%). Enter 0 if you do not qualify for the discount. 
 
Subtract your student discount from your conference price. 
If you are subscribing to Midwifery Today (see the Subscription section above), enter your subscription price. Enter 0 if you are not subscribing at this time. 
If you are paying CEU fees (see the CEU section above), enter the total amount of your fees now. Enter 0 if you are not paying CEU fees at this time. 
Friday Lunch Social: Registrants $15 / Non-registrants $25 
TOTAL PAYMENT - Add the 4 items above to calculate your total payment. 

How will you make your payment? NOTE: All prices shown in U.S. dollars.

  •  Check
  •  Visa
  •  MasterCard
  •  Discover
  • Cash—Do not mail cash.

Payment by Check or Money Order

If you pay by check or money order, make it payable to Midwifery Today. Payment must be made in U.S. funds.

Payment by Credit Card

All credit cards will be charged in U.S. dollars at the listed U.S. prices.

Refund and Cancellation Policy

If you cannot attend the conference after you have registered and sent in your payment, you must contact the office and let us know on or before the cancellation date. You will be refunded the amount you paid minus 30% for processing. The cancellation date for the conference is February 20, 2017. No refunds after this date.

Form for Credit Card Payment

Please complete the following items if you are paying by Visa, MasterCard or Discover.

Amount to be charged to your credit card in U.S. dollars 
Account number (Visa/MasterCard/Discover):
Must be 16-digit number starting with a “4” or “5 or”6”
 
Expiration date  [ month / year ] 
3-digit security code (Discover only) 
Name as it appears on the credit card  [ please print ] 
Billing address if different from above  [ please print ]
 
 
 
Billing phone and/or e-mail address  [ please print ] 
Signature 

6. Information

How to Submit Registration and Payment

  1. Please read and complete all of this form. Be sure to keep a copy for your records.

  2. You may mail this form with your payment in U.S. funds to Midwifery Today. If you pay by credit card, you may fax this form to Midwifery Today. You may also register by phone or e-mail. (Do not send credit card details by e-mail.) Use the Contact Addresses and Telephone Numbers at the bottom of this form.

  3. Registrations must be received in office at Midwifery Today no later than March 22, 2017. If you cannot mail your registration early enough for it to be received prior to this deadline, please register at the conference.

Location of Conference/Hotel

Please see information on location and accommodations on our Eugene conference gateway page.

Contact Addresses and Telephone Numbers

Midwifery Today
P.O. Box 2672
Eugene, OR 97402-0223
U.S.A.

conference@midwiferytoday.com
1-800-743-0974  [ U.S. and Canada only ]
+1 541-344-7438
+1 541-344-1422  [ fax ]

Conference Updates

Up-to-date conference information can be found on the Midwifery Today website:

www.midwiferytoday.com/conferences/Eugene2017/updates.asp

Disclaimer

Midwifery Today, Inc., cannot be held responsible for natural disasters, labor strikes, acts of war or other events that may cause the conference to be rescheduled. Midwifery Today, Inc., reserves the right to postpone the conference to another time, date and if necessary, location. In the event of a conference postponement no refunds will be issued. Registrants can transfer their fees toward any other Midwifery Today conference.

Midwifery Today, Inc., reserves the right to substitute teachers and/or classes. The views and opinions expressed by teachers are their own and may not represent the views and opinions held by Midwifery Today, Inc., and its staff members.