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Cuidiú Class Membership Sign up Form
Please provide details here of the new Cuidiú Family Member
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* Indicates required question
Email
*
Your email
What is your name?
*
Your answer
What was the class the new member(s) attended?
*
Antenatal - Regular Class
Antenatal - Lottery Funded Class
Antenatal - Relax Stretch Breathe Class
Antenatal - Student Class - No Capitation Due
Antenatal - VBAC Class
Antenatal Sector - Breastfeeding Preparation Class
Breastfeeding Sector - Breastfeeding Preparation Class
Required
What date did the class take place (last date if spanned several)?
*
MM
/
DD
/
YYYY
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