HYPNOBIRTHING REGISTRATION FORM
Please complete the form below. I will contact you within 24 hours to confirm enrolment. Thank you!
Mother's name
*
First Name
Last Name
Birth partner's name
First Name
Last Name
E-mail
*
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State
Post code
Estimated Due Date
-
Day
-
Month
Year
Date Picker Icon
Program Type
GROUP hypnobirthing course - ($595)
ONLINE hypnobirthing course via zoom ($545)
PRIVATE hypnobirthing course - ($925)
Hypnobirthing REFRESHER - ($290)
Positive CAESAREAN Course - ($395)
Hypnobirthing INTENSIVE Course - ($660)
Hypnobirthing course dates you wish to enrol in.
Care provider name
Eg. Midwife/Doctor/OB
Location/hospital
How many weeks pregnant will you be when you begin classes?
Is there any important information you need me to be aware of before classes commence?
Eg previous pregnancies, medical or emotional health concerns.
Do you have any dietary requirements or food allergies?
Additional information
Do you have any questions about the program? Please leave them here and Rosie will be in touch asap.
Payment details
To secure your place, a $150 non-refundable tuition deposit is requested. Final payment is due 7 days prior to course start date. Payment can be made by direct deposit or PayPal. Please note that your enrolment is not confirmed until deposit has been received.
Direct Deposit : Rosie Fitzclarence BSB: 063551 Acc. 10148447 PayPal : rosie@geelongborn.com.au (debit or credit card).
SUBMIT FORM
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