Class Registration

You are registering for:
Childbirth Preparation
Location: Family Birth Center 3rd floor
Instructor: Childbirth Instructor
Dates:  Mon December 2, 2013 6:30 PM - 9:00 PM
Mon December 9, 2013 6:30 PM - 9:00 PM
Mon December 16, 2013 6:30 PM - 9:00 PM
Mon December 23, 2013 6:30 PM - 9:00 PM
Mon December 30, 2013 6:30 PM - 9:00 PM
Mon January 6, 2014 6:30 PM - 9:00 PM
Fee: $110

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