BIRTH PREPARATION & BIRTH PARTNER WORKSHOP
BOOKING FORM
Name
*
First Name
Last Name
Birth Partner Name
Email
*
example@example.com
Confirm Email
*
example@example.com
Mobile Phone Number
*
How many weeks pregnant will you be on the day of the Workshop?
Do you have any Medical Conditions?
*
No
Yes - Please give details below
Medical Details
Booking Payment
*
BACS Bank Transfer - details will be sent in confirmation email
Card Payment - complete below
Card Payment
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Birth Partner Workshop
£
65.00
Price is per couple and includes PDF booklet
Total
£
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please verify that you are human
*
Submit
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