Class Registration Form
Instructor: Corri Martella corri@nursecorri.com (559)972-7200
Name
*
First Name
Last Name
Cell phone # for texting
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
May I share with you information about other classes you may be interested in?
*
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Nurse Corri classes?
*
For Journey of Childbirth registration, when is your due date and where are you having your baby?
Due Date
Where are you having your baby?
For Breastfeeding Basics registration. If you have already birthed your baby, what is your baby's name and birthday?
Baby's name
Birthday
I understand that this is an educational class and that Nurse Corri is not providing medical services, advice or treatment, and that Nurse Corri is not acting as my physician, medical provider, or my child’s provider. I give permission for photographs or videos taken of me while participating in the class to be used in social media and marketing/public relations materials in the promotion of Nurse Corri and her classes. At any time during class, I can let the instructor know that I prefer not to be photographed or videotaped.
*
My Products
prev
next
( X )
October 22nd, 2023 - Journey of Childbirth - 2pm-3:30pm Pacific Standard Time
Online via Zoom!
$37.00
$
37.00
Quantity
1
2
3
4
5
6
7
8
9
10
November TBD, 2023 - Breastfeeding Basics - 6:30pm-8pm Pacific Standard Time
Online via Zoom!
$99.00
$
99.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Submit
Submit
Should be Empty: