HypnoBirthing® Course Registration
Yes, I would like to register for the full HypnoBirthing® Antenatal Class at RM1100.00 per couple.

Terms and Conditions:
* A deposit of 50% is to be made together with the submission of this form as confirmation of your class booking.
* The deposit is non-refundable unless medical evidence is provided. (Selected medical condition)
* The remaining 50% of payment is to be paid a week BEFORE the first class.
* All classes must be completed according to schedule provided. Any additional classes beyond schedule is chargeable at RM200 per class.
* Classes will be held at respective practitioner's premises.

Step 1 - Bank into Maybank Acc : 1074 2408 2933 (CHAN JE CHIH)
Step 2 - Key in your full name in the banking reference
Step 3 - Email the proof of payment and your name to gentlebirthmalaysia@gmail.com
Step 4 - Proceed with the online registration as below
Step 5 - You will receive a confirmation email within 2 working days from your registration.

For more information on the class, kindly contact Jaye @ 012-4111501.

Please be assured that all your personal details are secured and protected.

Mummy's Full Name
Your answer
Contact Number (Mobile)
Your answer
Mummy's Email
Your answer
Daddy/Birth Companion's Name
Your answer
Daddy/Birth Companion's Contact Number (Mobile)
Your answer
Daddy/Birth Companion's Email
Your answer
Expected Due Date
Your answer
Doctor's Name
Your answer
Hospital/Place For Baby's Birth
Your answer
How many weeks(gestation) are you in when class begins?
Your answer
Amount Paid
Your answer
Your email address
Your answer
Transaction reference code
Your answer
Which class would you like to sign up?
By clicking on the Agree button, we accept to the terms and conditions stated above
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms