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Registration Form
Complete the Student Registration form and return it to us by mail. Then send your
$150.00 registration fee via the PayPal link below, or by mail with a money order or check also include your registration form. After we recieve your information and payment,
You will recieve a welcome packet by mail with all necessary forms and instructions to begin your studies.
Make checks payable to
J. Mereinda Fisher
409 Madison Creek Court
Lyman SC 29365
864-439-7195
NAME_________________________________
ADDRESS______________________________
CITY/STATE/ZIP_______________________
PHONE____________HOME____________CELL
EMAIL________________________________
WHAT ARE YOUR FUTURE GOALS?
_____________________________________
_____________________________________
_____________________________________
WHY HAVE YOU CHOSEN MIDWIFERY?
_____________________________________
_____________________________________
_____________________________________
PLEASE LIST ANY PREVIOUS EDUCATION:
_____________________________________
_____________________________________
_____________________________________
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