STEP 1: COMPLETE & SUBMIT INFORMATION STEP 2 USE ZELLE OR PAYPAL BUTTON FOR $75 PAYMENT

Name

First Name

Last Name

Partner/Support Person

Email Address

Telephone

Baby's Due Date

Baby #

OB/Midwife's Name

Location of Birth

How did you hear about this class?

My Birth Goals

I'm registering for the class on

I would like more information about Birth Help's Doula Support

USE ‘SUBMIT’ BUTTON TO COMPLETE THE REGISTRATION FORM, THEN SECURE YOUR PLACE BY MAKING YOUR $75 PAYMENT VIA ZELLE (doula@birthhelp.com) or PAYPAL.

**To use Zelle, make $75 Payment to doula@birthhelp.com or Birth Help LLC.**

Form - Comfort Measures Class

To use Zelle, make $75 Payment to doula@birthhelp.com or Birth Help LLC.

Birth Help

**To use Zelle, make $75 Payment to doula@birthhelp.com or Birth Help LLC.**