20 years of excellence

If you are a professional in the medical, educational or social service fields, call Birthways at (800) 882-3559
birthways@empathy belly.org

Birthways Childbirth Resouce Center, Inc.
Warranty Registration

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Warranty Registration | Informed Consent Form | Downloads

Please fill out and submit the warranty registration form below for quick online registration. You can also print and mail/fax the PDF version.

"THE EMPATHY BELLY"® PREGNANCY SIMULATOR
WARRANTY REGISTRATION FORM

Name:

Name of Organization:

Complete Mailing Address:

Work Phone:

Date of Purchase:

Email Address:

Occupation/Profession:

Number of years in Profession:

Gender:

 Female    Male

For what purpose(s) will you be using The Empathy Belly? (check all that apply)

 Teen Pregnancy Prevention
 Prenatal Education
 Domestic Violence Prevention
 Museum Exhibit
 TV Show, Movie or Theatre

 Life Skills Education
 Medical Training
 College Education
 Private Counseling
 Actor's Training

From whom did you purchase your Empathy Belly(s):

 Birthways, Inc.
 Nasco
 Health Edco
 Childbirth Graphics
 Sax School Specialty
 Directional Learning
 

 Denoyer-Geppert
 Japan Family Planning Assoc.
 The Health Connection
 Camera Mundi
 Other: 

Where have you seen ads about The Empathy Belly in any of the following?
(check all that apply)

 Nasco Catalog
 Health Edco Catalog
 Childbirth Graphics Catalog
 Sax School Specialty Catalog
 Directional Learning Catalog
 Denoyer-Geppert Catalog
 A.A.F.C.S. Journal
 F.C.C.L.A. Publication "Advisor"

 A.S.P.O. Publication "Genesis"
 I.C.E.A. Journal
 Healthy Teen Network Publication
 What's New in Home Economics Magazine
 Birthway's Website of The Empathy Belly
 Other: 

What are the most important reasons influencing your purchase of The Empathy Belly? (check all that apply)

 The Product's Reputation
 Previous Experience or "tried it on"
 Features (i.e. Symptoms Simulated)
 Hands-on Teaching Tool
 Teacher Training Materials Included
 Repeat Purchaser of the Product
 Quality & Durability

 Conference or Workshop Exhibit
 Received a Grant to Purchase
 B.E.T.A. Trust Fund Assistance
 Word of Mouth Recommendations
 TV, Radio or Newspaper Publicity
 Free, Promotional Videotape of Product

What would make it possible for you to buy more Empathy Bellies that you want?

If you have any questions or comments about this warranty registration, or about your Empathy Belly, please feel free to contact us at Birthways at (800) 882-3559 or email us at birthways@empathybelly.org

 

NOTE: ALL INFORMATION IS FOR WARRANTY/INTERNAL USE ONLY AND WILL NOT BE SOLD OR RENTED AS PART OF ANY MAILING LIST

 

 



Home | How to Order | About the Empathy Belly | Features | More Features
Medical Training | Expectant Fathers | Teenagers | Sources of Funding
Troubleshooting | About Us | The Empathy Lungs | New! Childbirth Classes

Warranty Registration | Informed Consent Form | Downloads



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