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In order to reserve your space in class, please complete the info and submit the form below, then pay your deposit through the PayPal button provided, below or call me at (985) 303-9378 to make other arrangements!

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Mother's Name *

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Last

Partner's Name *

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Last

Estimated Due Date *

Who is your OB or Midwife? *

Planned Place of Birth? *

Phone Number *

Alternate Phone Number *

Email *

Address *

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City

State

Zip Code

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How did you hear about this class? *

please describe *

Are you or your partner Active Duty Military? *

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Comment *

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