Membership Application

Our membership is open to all postpartum caretakers. Anyone interested in being a member is required to apply for caregiver certification. All who become members are then listed on the website and referral line.

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Please fill out the form below and send a check payable to:
Gentle Hands Referral Service
c/o Lisa Nero
1096 Flatbush Avenue
Brooklyn, NY 11226

Regular Membership - 1 year for $60.00
Regular Membership - 2 years for $95.00

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Phone:

E-Mail:

Do you wish to have a home phone number listed in the Directory?: Yes    No

Professional Title:

Certification: Enter Here...

Areas Served: Enter Here...

Additional services offered: Enter Here...