Class Registration

You are registering for:
Childbirth Preparation Class
Location: Family Birth Center 3rd floor
Instructor: Childbirth Instructor
Dates:  Wed August 7, 2013 6:30 PM - 9:00 PM
Wed August 14, 2013 6:30 PM - 9:00 PM
Wed August 21, 2013 6:30 PM - 9:00 PM
Wed August 28, 2013 6:30 PM - 9:00 PM
Wed September 4, 2013 6:30 PM - 9:00 PM
Wed September 11, 2013 6:30 PM - 9:00 PM
Fee: $110

Please give us your contact information:
* First Name:
* Last Name:
* Address:
Address 2:
* City:
* State:
* ZIP Code:
* Phone:
Company:
* Email:
Due Date:
Doctor's Name:
Coach's First Name:
DSHS ProviderOne card: