COMMUNITY SUPPORT FUND APPLICATION | LIDA

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631.574.2205 | info@lidoulas.com

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Community Support

Fund Application

To apply, please take the time to fill out the information below.

First Name

Last Name

Email

Phone

Parent Date of Birth

Address

Suite, Apt, Unit, etc.

City

State

Zip Code

How many children do you have (not including this pregnancy)?

How did you hear of CSF or Black Maternity Wellness Collective?: For example: at a health fair, through a perinatal network, through the health department, a health provider, a friend, etc.):

CONTACT US

Long Island Doula Association, Inc.

PO Box 555

East Islip, NY 11730

Tel 631.574.2205

Email info@lidoulas.com

Join our email list!

Thanks for submitting!

© 2014 Long Island Doulas Association, Inc. All rights reserved.

LIDA, Inc., is a not-for-profit corporation whose purpose is to promote the mutual advancement of the interests of it's members who may be, but are not required to be doulas. As such, LIDA, Inc., cannot and does not accept any responsibility for the individual conduct of its members and any contracts between a member and her client are exclusive to the member and her client.

Contact us at info@lidoulas.com for information on our association, our mission or our "Community Support Fund". You may contact members directly from our "member lists" to discuss specific services.

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