Membership Application

First name

Last name

Phone

Email (by entering your email you agree to receive emails from the VA EOLD Collective)

Website (if applicable)

Mailing Address

Gender

*Knowing someone's gender is essential for providing respectful and personalized care, as it may relate to religious practices, cultural traditions, or trauma-informed needs. This ensures individuals feel safe, honored, and supported in their preferences.

Age

Reason for joining the collective:

I am interested in becoming an EOLD.

I have worked in a profession closely associated with EOLD and want to see it grow.

I have benefited from the use of doula services in the past.

Interested to learn more about the field of end of life doulas.

To access written/published resources and online education, such as webinars.

To get referrals from prospective clients.

To network with other EOLDs and professionals in the field.

To have access to the social media private EOLD groups.

Statement of Purpose: Please provide a brief statement explaining why you are interested in joining our Death Doula Collective and how you believe your skills and experience can contribute to our mission.

Please select the level of your availability and commitment.

Yes, I am willing to take on client referrals.

Yes, I am willing to volunteer with the collective.

Yes, I am interested in mentoring new doulas.

Your Death Doula credentials

In this section we are interested in learning about you and your experience. If you have not received official training or certificates, please type 'No official training' or 'No official certificates' in the respective field, and then describe your experience in the experience field.

Training: (Please list any relevant training or workshops you have completed)

Certification(s): (Please list any relevant certifications)

Experience: Please describe your work experience as a death doula, including volunteer or paid work.

To help us verify your credentials and ensure eligibility, please provide us with relevant documents or images for review. Note, if no documents are included with your application, your submission will show as 'Unverified'. (Members may update their application and submit the required documentation at any time to be reviewed for verification to membership@vaeoldcollective.org).

Upload IMAGE files to support your training and/or certificates for us to review.

Upload DOCUMENT files to support your training and/or certificates for us to review.

How did you hear about the Virginia EOLD Collective?

The VA EOLD Collective Facebook group

The VA EOLD Collective website

Word of Mouth

Referral from a collective member

Are you interested in group networking and peer support contact information sharing?

Yes

No

Would you like to be added to the online doula directory?

Yes

No

Upload headshot photo for online directory