hybrid class registration form

hybrid online/in-home private class

* Indicates required field

birthing person's name *

First

Last

pronouns *

birth partner's name *

First

Last

pronouns *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Estimated Due Date *

Planned place of birth *

How did you hear about this class? *

Please suggest a time frame, typical days/times that might work best for scheduling you're 2.5 hour private in-home class *

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? *

Promo Code *

Submit

Full payment is required to activate your seat in the eClass and reserve your spot in the group class.
Venmo: Elizabeth-Varaso
PayPal: elizabeth@mamabirdbirth.com
Pay with a credit card from this website (below) or mail a check (address below)

Click here to pay online

To pay by check, mail a check made out to "Elizabeth Varaso" to
5137 Race Street
Philadelphia, PA 19139