Registration Form
Please enter details on the form below and I will then contact you shortly with confirmation of enrollment and account details for direct payment.
Your Name
*
First Name
Last Name
Partners Name
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guestimated due date
-
Month
-
Day
Year
Date
Course
*
• Group Class
• Private Class
• Refresher
• Online Course Basic
• Online Course Value
• Online Positive Caesarean
• Private session upgrade
• Positive Caesarean - private class
Date of course
-
Month
-
Day
Year
Date
To hold your place, a $150 non-refundable course deposit is requested. Final payment is due 7 days prior to course start date. Payment can be made by direct deposit.
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