Midwifery Today Conference
“Out of Many, One: Unity in Midwifery”
Harrisburg, Pennsylvania • April 23–27, 2014
Registration Form

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 Pre-Conference
  •  Thursday Pre-Conference
  •  Friday Conference
  •  Saturday Conference
  •  Sunday Conference
  •  Monday Post-Conference

Please tick 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 23, 2014: Pre-Conference

Select a full-day course (Either 8:30 am – 4:30 pm OR 9:00 am – 5:00 pm; see program):

  •  A1
  •  A2 (Sorry; this class is full)
  •  A3
  •  A4

Thursday, April 24, 2014: Pre-Conference

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

  •  B1
  •  B2
  •  B3
  •  B4

Friday, April 25, 2014: Conference Day One

Select one class (1:00 pm – 3:00 pm):

  •  C1
  •  C2
  •  C3
  •  C4

Select one class (3:15 pm – 4:45 pm):

  •  D1
  •  D2
  •  D3
  •  D4

Saturday, April 26, 2014: Conference Day Two

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

  •  E1
  •  E2
  •  E3
  •  E4

Select one class (1:30 pm – 3:00 pm):

  •  F1
  •  F2
  •  F3
  •  F4

Select one class (3:30 pm – 5:30 pm):

  •  G1
  •  G2
  •  G3
  •  G4

Sunday, April 27, 2014: Conference Day Three

Select one class (11:15 am – 12:45 pm):

  •  H1
  •  H2
  •  H3
  •  H4

Monday, April 28, 2014: Post-Conference

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

  •  I1 (Sorry; this class is full)

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 72 pages of 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 meals, transportation or overnight accommodations. Look up your 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.

    Students who pay tuition 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 CEUs, dinner or subscriptions.] Enter the prices that apply to you on the lines provided in the payment section of this form.

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

    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
  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.

5. Conference Prices and Payment

* No discounts apply to
subscriptions, CEUs or dinner.
Walk-in registrants are always welcome. Just pay when you arrive.
Postmark on or before
November 18, 2013
Postmark on or before
February 10, 2014
April 10, 2014
(in office deadline)
Subscriber Non-Subscriber Subscriber Non-Subscriber Subscriber Non-Subscriber
1 day$130$145$140$155$150$165
2 days$260$290$280$310$300$330
3 days$335$380$360$405$385$430
4 days$455$515$490$550$525$585
5 days$575$650$620$695$665$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 April 10, 2014, 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, please register at the conference. Simply pay the April 10, 2014, prices when you arrive 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. 
Monday Class (Use 1-day price if attending Monday only or all 6 days) 
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%; you may add in the Monday class if registering for all 6 days). 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 Night Dinner Social: Registrants $10/Non-registrants $35. Enter 0 if you are not buying dinner at this time. 
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

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 call 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 March 10, 2014. No refunds after this date.

Form for Credit Card Payment

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

Amount to be charged to your credit card in U.S. dollars 
Account number (Visa/Mastercard)*
*Must be 16-digit number starting with a “4” or “5”
 
Expiration date  [ month / year ] 
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 April 10, 2014. 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/Hotels

Please see information on location and accommodations on our Harrisburg 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 Web site:

www.midwiferytoday.com/conferences/Harrisburg2014/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.