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Titus 2 Birthing Christian Childbirth Education Training Registration

This registration form is for those who desire to enroll in the Titus 2 Birthing CCCE training program. You must fill out this form and mail it in with your $85 non-refundable registration fee and a copy of your high school diploma to receive your training materials and student workbook.
In order to attend the Intensive, held once each year, you must have completed four of the nine module worksheets, turned in both your evaluation forms, your signed organizational documents, and proof of current CPR certification.

2005 Titus 2 Birthing Intensive Workshop

Titus 2 Birthing: Christian Childbirth Education Certification

Registration Form

Name _________________________________________________________________________

Address __________________________________ City/State/Zip ________________________

Home Phone ______________________________ Work Phone __________________________

Married? ______ Name of Spouse: _________________________ Years Married ____________

Names/Ages of Children: _________________________________________________________

Why are you interested in childbirth education training? ________________________________

_______________________________________________________________________________

Previous childbirth education experience, if any? ______________________________________

_______________________________________________________________________________

Are you a Christian? _______ Please provide a brief testimony __________________________

_______________________________________________________________________________

Do you see childbirth education as ministry? ____ How? _______________________________

_______________________________________________________________________________

How do you see yourself in regards to the Titus 2 woman described in Titus 2: 1-8?

_______________________________________________________________________________

Please list your email address, if you have one. _______________________________________

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