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Course Registration
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Email
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Record my email address with my response
First and Last Name
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Your answer
Phone Number
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Your answer
Cycle type (choose all that apply)
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Typical cycles (24-39 days)
Long irregular cycles (> 40 days)
Short irregular cycles (< 23 days)
Postpartum (cycles have not returned)
Post-hormonal birth control
Premenopause
Required
How did you find out about me?
Referred by friend
Through social media
Through a FAM/NFP website
Other:
Payment Methods
Venmo: @johnna-wilford
Paypal: classicsj11@gmail.com
Payment Options - YOUR REGISTRATION IS NOT COMPLETE UNTIL YOU'VE SUBMITTED YOUR DEPOSIT PAYMENT
Pay In Full (all sessions) - $120
Payment Plan (all sessions) - $40 at each session
Pay In Full (2 sessions, no family planning) - $80
Payment Plan (2 sessions, no family planning) - $40 at each session
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