Class Registration

You are registering for:
Childbirth Preparation
Location: Family Birth Center 3rd floor
Instructor: Childbirth Instructor
Dates:  Wed November 6, 2013 6:30 PM - 9:00 PM
Wed November 13, 2013 6:30 PM - 9:00 PM
Wed November 20, 2013 6:30 PM - 9:00 PM
Wed December 4, 2013 6:30 PM - 9:00 PM
Wed December 11, 2013 6:30 PM - 9:00 PM
Wed December 18, 2013 6:30 PM - 9:00 PM
Fee: $110

Please give us your contact information:
* First Name:
* Last Name:
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Address 2:
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Due Date:
Doctor's Name:
Coach's First Name:
DSHS ProviderOne card: