Midwifery Today Conference
“Promoting Midwifery: Skills from Around the World”
Byron Bay, Australia • 4–9 November 2014
Registration Form

JOIN US! There is still plenty of space to register for this important event.
Registration deadlines: Mailed-in pre-registration deadline is 23 October 2014, in office
and the online registration deadline is 2 November 2014. (See details).

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

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.

  •  Tuesday Pre-Conference
  •  Wednesday Pre-Conference
  •  Thursday Pre-Conference
  •  Friday Conference
  •  Saturday Conference
  •  Sunday 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 D1 through D4 and also one class from E1 through E4. Class descriptions can be found in the conference program.

Tuesday, 4 November 2014: Pre-Conference

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

  •  A1
  •  A2

Wednesday, 5 November 2014: Pre-Conference

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

  •  B1
  • B2 — Sorry; this class is full.
  •  B3
  •  B4

Thursday, 6 November 2014: Pre-Conference

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

  •  C1
  • C2 — Sorry; this class is full.
  •  C3
  • C4 — Sorry; this class is full.

Friday, 7 November 2014: Conference Day One

Select one class (1:00 pm – 2:30 pm):

  • D1 — Sorry; this class is full.
  • D2 — Sorry; this class is full.
  •  D3
  • D4 — Sorry; this class is full.

Select one class (2:45 pm – 4:15 pm):

  •  E1
  •  E2
  •  E3
  •  E4

Saturday, 8 November 2014: Conference Day Two

Select one class (1:30 pm – 3:00 pm):

  •  F1
  •  F2
  •  F3
  •  F4

Sunday, 9 November 2014: Conference Day Three

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

  • G1 — Sorry; this class is full.
  •  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 $87.50 on Conference Prices! Subscribers to Midwifery Today are eligible for a 10% discount on registration prices. If you are not currently a subscriber, you can obtain the discount 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 StatesUS $55
CanadaUS $68
InternationalUS $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

  1. Prices are listed in U.S. dollars.

  2. Prices do not include meals, transportation or overnight accommodations. Look up your price in the table in Section 5.

  3. By registering early, you become eligible for reduced conference prices. The early registration deadlines are 30 June 2014 and 29 August 2014. Prices are shown in the table in Section 5 for each deadline.

    Conference prices are determined by the postmark date on your registration. If you submit your registration by telephone, fax or e-mail, the postmark date will be deemed to be the date that Midwifery Today receives your communication. Payment must be made by the deadline to be eligible for reduced prices.

    Walk-in registrants pay the regular price listed in the table when they arrive at the conference.

  4. If you are eligible for one of the special discounts described below, check the appropriate box and adjust the prices as directed.

    Discounts

    10% Subscriber Discount

    If you are a subscriber to Midwifery Today, you may deduct 10% from your conference price. Subscription may be started at time of conference registration, but must be current at time of registration to qualify for discount. Midwifery Today magazine is an English language publication. Student discount does not apply to subscription prices.

    20% Student Discount

    If you are a full-time student, you may deduct 20% from your conference price. You must register for three or more days; and you must submit, with your registration, proof of full-time student status.

    If you qualify for a discount, please select the appropriate box below and enter the amount of your discount in the Payment section of this form.

    •  Subscriber  [ 10% ]
    •  Full-time student  [ 20% ]
    •  Subscriber and full-time student  [ 30% ]

5. Conference Prices and Payment

Attendance Walk-in registrants are always welcome. Just pay when you arrive.
Postmark on or before
30 June 2014
Postmark on or before
29 August 2014
Regular prices
(after 29 August 2014)
1 dayUS $155US $165US $175
2 daysUS $310US $330US $350
3 daysUS $415US $440US $465
4 daysUS $570US $605US $640
5 daysUS $620US $660US $700
6 daysUS $775US $825US $875

23 October 2014 is the deadline for mail-in registrations, in office. 2 November 2014 is the online registration deadline. Please note: Registrations received after 23 October are not guaranteed chosen class placement.

After 23 October 2014, registrations are only accepted online with credit card or in person at the conference. Online registrations are accepted until 2 November 2014. Online registrations submitted after 23 October require the following to be shown upon arrival at the conference:

  1. a printed copy of the registration confirmation
  2. proof of payment (a printed copy of the credit card transaction receipt)
  3. the credit card used for the transaction
  4. proof of student status, if applying for student discount

If you cannot submit your registration by November 2, please register in person. Simply pay the regular price when you arrive at the conference. (Payment methods: Cash in U.S. or Australian dollars; Visa or MasterCard in U.S. dollars.) Class offerings may be limited, so please contact Midwifery Today before you arrive. To register at the conference, you may print a copy of the registration form by printing out this page; fill it out and bring it to the conference for speedier registration. 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 a discount (see the Discounts section above), enter the amount of your discount (multiply your conference price by 10%, 20% or 30%). Enter 0 if you do not qualify for a discount. 
 
Subtract your 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. 
Add the items above to calculate your total payment. 

How will you make your payment? NOTE: All prices are 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. dollars.

Payment by Credit Card

All credit cards will be charged in U.S. dollars at the listed U.S. prices. We cannot make any guarantee of exchange rate. All fees for fund conversion are the responsibility of the payer.

Payment by Bank Transfer

Due to the large and unpredictable fees charged by intermediary banks for international payments, we are only able to accept payment by bank transfer in amounts greater than US $1,000.00. Please contact admin@midwiferytoday.com for payment details.

Refunds

No refunds will be given after 25 September 2014. A processing fee equal to 30% of the amount paid will be deducted from any refund given on or before 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 23 October 2014. If you cannot submit your registration early enough for it to be received by this deadline, please register at the conference.

Location of Conference/Hotels

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

Contact Addresses and Telephone Numbers

Midwifery Today
P.O. Box 2672
Eugene, Oregon 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:

midwiferytoday.com/conferences/Australia2014/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.