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
2 digit month, 2 digit day, 4 digit yearDate
Do you have a doula?
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:
Where did you find out about our classes?

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

HypnoBirthing Childbirth Class Deposit$100.00

Total $0.00