HypnoBirthing® Institute

Registration Form




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

Name: __________________________________________

Class Start Date: __________________________

Hours: ________________________________

Location: __________________________________________

Tuition Fee: $245.00 (Includes textbook, 2 audio practice tapes, and numerous handouts)

Home Tel. ___________________ Work Tel. _________________

_____________________________________________________________
Address

_____________________________________________________________
City - State - Zip

Heidi Guiliano
5 Harrison Ln
Wakefield, Ma. 01880