Registration HypnoBirthing® Name * First Name Last Name pronoun She/He/They Date of Birth MM DD YYYY Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Name of Birth Companion * First Name Last Name Relationship to Birth Companion * Please fill in your preferred identifying term for use in the birth journey example, Mom, parent, birthing person... Care Provider Name & Title * Birthing Facility * Have you birthed before? If yes, what baby number is this? * When is baby expected? * How many weeks pregnant will you be when you begin classes? * Do you have any health or obstetric concerns? * How did you hear about us? Registration Option In-Person Series January 5th ($375.00) In-Person Series April 16th ($375.00) Thank you!