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registration

Please complete the below form to reserve your place as the course is limited to 10-12 couples. For the May 2010 Brussels course, please pay tuition by transfer to Cristin Tighe 377-0122021-32 (put in memo: Birth Works). This is a Belgian account, other details if you need are: IBAN BE28363047789920 and BIC(Swift) BBRUBEBB. Tuition per couple is €185 early discount if paid by 5 May and €225 after. Your space is only guaranteed once you pay ahead. If you have questions, please email Cristin.

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Name *
E-mail Address *
Name of Birth Partner *
Relationship to you *
Telephone # (best to reach you) *
Telephone # (other) *
Address *
Which course will you attend? (date and city) *
Due Date *
Is it your first child? *
Have you decided where you are giving birth? If so, please share. *
What do you hope to get from the course? *
Are their specific topics you want us to cover? *
Is there anything else you would like to share with us?

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 Educating and empowering mothers, starting in pregnancy, is a significant way to create a peaceful world for our children!

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