combo class registration form

Combination class registration

(Online Birth Class paired with a 2 hour in-person or Zoom private session)

* Indicates required field

birthing person's name *

First

Last

pronouns *

Email *

Phone Number *

birth partner's name *

First

Last

pronouns *

Estimated Due Date *

Planned place of birth *

How did you hear about this class? *

I would like to have my private session *

In-person in my home Via Zoom

If in-home, please provide your address *

Line 1

Line 2

City

State

Zip Code

Country

Please suggest a time frame, typical days/times that might work best for scheduling your 2 hour private session *

What are you hoping to get out of this class? *

Is there anything else about yourself, your experience with pregnancy or your plans for birth that you feel would be helpful for me to know? *

Submit

Full payment is required to access your online Confident & Prepared Birth Class and schedule your 2 hour private session. Please pay via Venmo or PayPal, or contact elizabeth@mamabirdbirth.com if you need to make other payment arrangements.

In-person private session option: $250
Zoom private session option: $175