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The Bradley Method
® of Natural Childbirth
Registration Form
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* Indicates required question
Your Name & Coach's Name (partner)
*
Your answer
Your Email:
*
Your answer
Due Date:
*
MM
/
DD
/
YYYY
Preferred Phone Number(s):
Your answer
Mailing Address:
*
Your answer
Name of your OB/birth attendant:
*
Your answer
Name of the place of birth:
*
Your answer
Any questions you or coach have for me?
Your answer
What days of the week and times work best for you and your partner?
*
Your answer
I understand that Melissa Smafield is a provisional trained childbirth instructor and is teaching about birth and is not practicing medicine.
*
YES!
Required
I understand $375 is due before scheduled class 1 date.
*
YES!
Required
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