HypnoBirthing® Institute Registration Form

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Please enroll me/us in the upcoming five-week HypnoBirthing Childbirth Education Class.

Name: ______________________________________________________

Class Start Date: _____________________________________________

Hours: ______________________________________________________

Location: ____________________________________________________

Home Tel. ___________________ Work Tel. _______________________

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Address

_____________________________________________________________
City - State - Zip


To register for class pay $150 deposit through paypal.

or send a check to:
Heidi Guiliano
4 Glenwood St.
Natick, Ma. 01760