Course Enrollment Form
Fill out the form carefully for registration
Pregnant Person's Name
*
First Name
Middle Name
Last Name
Partner's Name
First Name
Middle Name
Last Name
Mailing Address for Materials
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pregnant Person's E-mail
*
example@example.com
Partner's E-mail
example@example.com
Pregnant Person's Phone Number
*
Partner's Phone Number
What is the best way to reach you?
*
call, text, email
When is baby's expected due time?
*
Is this your first birth?
*
If no, please let me know about your first experience.
Where are you birthing your baby?
*
Please include name of facility.
What are your pronouns?
he, she, they, etc.
How did you hear about Noteworthy Births?
HypnoBirthing Course Dates
*
Please Select
Nov 5, 12, 19, Dec 3, 17 (no class Nov 26 and Dec 10)
Private Session - 5 in person classes
Private Session - 5 online classes
HypnoBirthing Refresher 1 Day
HypnoBirthing Refresher 2 Day
Fear Release
Stress Release
Birth Release
Postpartum HypnoMothering Workshop 3 Hours
Please choose the course date you want to register for from the drop down menu.
Is there anything else you feel I should know?
Submit Application
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