October/November 2020 ONLINE Hypnobirthing Australia™ Positive Birth Program

Hypnobirthing Australia™ Positive Birth Program - Enrolment Form
Congratulations on taking the exciting step to learn hypnobirthing and prepare for a beautiful and positive birth experience! The Hypnobirthing Australia™ Positive Birth Program includes:
- 12 hours of small group classes for the birthing mother and birth partner (via Zoom).
- Modern and relevant HypnoFolio of Resources, including course handouts, practice materials and visualisations.
- Deep relaxation/self hypnosis tracks (4 long play tracks) with self-hypnosis, music and affirmations.
- eBook ‘little book of hypnobirthing’.
- Practice video ‘Rehearsal for Birth’.
- Additional support from me right up until your birth.
OCTOBER LIVE ONLINE SMALL GROUP COURSE

Unit 1: Saturday 3rd October 10am - 1pm
Unit 2: Saturday 3rd October 2pm - 5pm
Unit 3: Saturday 10th October 10am - 1pm
Unit 4: Saturday 10th October 2pm - 5pm

NOVEMBER LIVE ONLINE SMALL GROUP COURSE

Unit 1: Saturday 14th November 10am - 1pm
Unit 2: Saturday 14th November 2pm - 5pm
Unit 3: Saturday 21st November 10am - 1pm
Unit 4: Saturday 21st November 2pm - 5pm
I wish to enrol in the Hypnobirthing Australia™ Positive Birth Program live online small group class run on:*

October 3rd & 10th 2020November 14th & 21st 2020
Mother's name:*
Mobile phone number:*
Email address:*
Address: (this is the address your course folio will be posted to)*

Street Address

Street Address Line 2

SuburbState

Post Code
Birthing Companion (name of spouse / partner etc.)
Relationship to mother:
Mobile phone number:
Birthing Assistant (if applicable):
Relationship (e.g. doula / friend etc.)
Care Provider name and title (e.g. Midwife / Doctor / Obstetrician)*
Hospital / Birthing Facility (name & location)*
When is baby expected?*
How many weeks pregnant will you be when you start class?*
Is this your 1st, 2nd, 3rd etc. baby?*
Is this birth a VBAC or is there any important information/medical conditions/psychological or psychiatric treatment you need me to be aware of before classes commence?
How did you hear about The Nurtured Seed - Hypnobirthing with Steph Dalo?
PROGRAM PAYMENT

The cost of live online course is $495 per couple. A deposit of $150 is required with your enrolment, and the remaining $345 will be due no less than 7 days prior to the course start date.
Please indicate which payment option you will be making for your $150 deposit today.

PayPal / Credit CardDirect Deposit (bank transfer)
DIRECT DEPOSIT PAYMENT DETAILS

Account Name: Stephanie Dalo The Nurtured Seed

BSB: 062 692

Account Number: 3965 7049
PAYPAL / CREDIT CARD PAYMENT
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Hypnobirthing Australia Positive Birth Program - DEPOSIT
$150.00AUD

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$0.00AUD

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Hypnobirthing Australia™ Positive Birth Program - Enrolment Form