First Name (required)

Last Name (required)

Your Email (required)

Skype address

What is your Spanish fluency level?

Are you currently practicing as a midwife? If yes, out of hospital, home or other? (required)

How many years of midwifery experience do you have?

How many births do you attend on average per year?

Do you currently hold a license as a legal midwife in your state? If yes, please describe:

Please describe in your own words why you want to be a part of the collective:

Please list any experience you have with consensus, circle work or alternative form of governance?

Please describe your experience with out of hospital or under-resourced birth settings:

Please describe any preceptorship or teaching experience you have: