Maternity Support Class Registration Form
Name
First Name
Last Name
OB Provider
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How would you like to be contacted
*
Please Select
Email
Phone
What class are you registering for?
Please Select
Childbirth Education
Breastfeeding Basics
Date of Class
Please Select
September 14, 2024 - Childbirth Class
October 15, 2024 - Breastfeeding Basics
November 9, 2024 - Childbirth Class
December 10, 2024 - Breastfeeding Basics
*Please not that the Childbirth Education classes are not virtual. They are in-person classes held at Archbold Memorial in Williams Auditorium.
If you are registering for an additional guest, please include their names below.
Name
First Name
Last Name
Submit
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