HypnoBirthing® Course Registration Form

HypnoBirthing® Course Registration Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Partner's Name*

First NameLast Name
Partner's Email Address:*
example@example.com
Partner's Phone Number*

Area CodePhone Number
Estimated Due Date*

MonthDayYear
Date
Do you have a doula?

YesNo
Name of Care Provider*

First NameLast Name
Name of Birthing Location:
Where would you like us to ship your class materials?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
All group classes are $350.00. Please select the series you would like to attend:*

Live-Online January Weekend Series on SaturdaysLive-Online January Weekday Series on TuesdaysPrivate Online ClassLive-Online April Weekend Series on SaturdaysLive-Online April Weekday Series on TuesdaysLive-Online June Weekend SeriesLive=Online June Weekday Series
Where did you find out about our classes?

FacebookSakinah Birth WebsiteInstagramMidwife/OBGYNBirth CenterHospitalFriend/Family-memberGoogleBIRTH FairThe HypnoBirthing Institute WebsiteThe Wright Doula CompanyDoulaOther
Please note there is a $100.00 non-refundable fee to secure a seat and the cost of class materials. The remaining balance is due 24 hours prior to the first day of class. There are no refunds after Class One. Thank you for understanding.*

I agree
**Please Note: Private make-up classes are done virtually and cost an additional fee.**

I understand

My Products

HypnoBirthing Childbirth Class Deposit$100.00

Total $0.00