BirthWorks Educational Course Registration Form
Your Name
*
First Name
Last Name
Preferred Name and Pronouns
Your Email
*
example@example.com
Phone Number
*
Estimated Due Date (If expecting)
-
Month
-
Day
Year
Address. Virtual participants will be sent a workbook.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Will your partner or another support companion be joining you for the entirety of the course?
*
Yes
No
Partner/Support Contact Information
Support Person's Name
*
First Name
Last Name
Support Person's Email
*
example@example.com
Support Person's Relationship To You
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Fall BirthWorks - In Person (2025)
Oct 26th and Nov 2nd, Sunday from 9 am to 4 pm EST. We will meet at 1108 W Washington St, Marquette MI
$
Free
Credit Card
Other
Who can we thank for introducing you to UPFDC's BirthWorks Course?
*
If you learned about it online, which platform?
What topics are you and your partner hoping we cover in this course?
*
Do you have any questions or anything you'd like us to know?
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