HypnoBirthing® Course Registration
Yes, I would like to register for the full HypnoBirthing® Antenatal Class at RM1500(individual class) 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 *
Contact Number (Mobile) *
Mummy's Email *
Mummy's Occupation *
Daddy/Birth Companion's Name *
Daddy/Birth Companion's Contact Number (Mobile) *
Daddy/Birth Companion's Email *
Daddy's Occupation *
Address *
Expected Due Date *
Doctor's Name
Hospital/Place For Baby's Birth *
How many weeks(gestation) are you in when class begins? *
Amount Paid *
Your email address *
Transaction reference code *
Which class would you like to sign up? *
Promo Code (if applicable)
How did you hear about us? *
By clicking on the Agree button, we accept to the terms and conditions stated above *
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