My Birth Geelong Registration Form

Registration Form

Hypnobirthing Australia™ Program- My Birth Geelong
Full name*

First NameLast Name
Partner/ support person's name (if applicable)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Email*
Phone number*
Which class dates do you wish to enrol in?*
What is your estimated due date?*
How many weeks pregnant will you be when class starts?*
What number baby is this for you?*
Where are you booked into to birth your baby (i.e. home, hospital, etc)?*
Who is your pregnancy care provider (i.e midwife, obstetrician, GP?)*
Do you have any dietary requirements?
How did you find out about this class?
Please tell us anything else you'd like us to know about you/ or add any questions. Thank you!
Please note that a $150 non-refundable deposit is required to secure your booking. The balance is due 7 days prior to class commencing. You can also pay the full amount upfront if you choose.

Cancellations with more than 7 days notice of class commencing are refundable, less the initial deposit.

PAYMENT DETAILS:

Bank Transfer/ PayID- felicity@mybirthgeelong.com.au

BSB-083646 ACC-538570988

PayPal- felicity@mybirthgeelong.com.au (credit card payments)
Should be Empty: