Class Registration

You are registering for:
Childbirth Preparation
Location: Family Birth Center 3rd floor
Instructor: Childbirth Instructor
Dates:  Mon July 7, 2014 6:30 PM - 9:00 PM
Mon July 14, 2014 6:30 PM - 9:00 PM
Mon July 21, 2014 6:30 PM - 9:00 PM
Mon July 28, 2014 6:30 PM - 9:00 PM
Mon August 4, 2014 6:30 PM - 9:00 PM
Mon August 11, 2014 6:30 PM - 9:00 PM
Fee: $110

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