Engage Birth Workshop

This workshop is $80 per couple and includes beverages, snacks, an Engage Birth Workbook and a gift bag of pregnancy and infant products. Space is limited and the deadline to register is Thursday, January 30th. Please arrive 5-10 minutes early to check in and be sure to dress in comfortable clothing appropriate for stretching and movement.

Your Name *

First Name Last Name

Who will be accompanying you to the workshop? *

Spouse Significant other Friend or family member

Partner's Name *

First Name Last Name

E-mail *

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

What is your due date? *

Who is your careprovider?

Have you taken any other Childbirth Education class?

yes no

Do you have any special dietary needs? (Please Specify)

Did your doula or other birth/postpartum practitioner refer you to this workshop? If so, please list their name and email so I can invite them to join us from 4-5pm for the Dancing for Birth portion.

Practitioner name

First Name Last Name

Email

example@example.com

*

Engage Birth Workshop $ 80.00

Enter coupon

Total $ 0.00

February 1, 2020