HypnoBirthing Class Registration Form
Congratulations on taking the first step towards achieving a calm and comfortable birth for your family!

Please follow the registration procedure below:

Group class fees: RM 1,000 per couple

Step 1 - Bank in 50% deposit to

1. Namrita's class in PJ
CIMB Bank Acc: 7014-97-1119
Acc Name: Preetesh Deora

2. Ruzanna's class in Ampang
Maybank Acc: 1622-0996-9285
Acc name: Ruzanna binti Abdul Rahman

3. Jessie's class in Puchong & Petaling Jaya (Dec 2018)
Maybank Acc:1142-3623-9821
Acc name: Ng Lai Ching

4. Adelin's class in Kota Kemuning
Public Bank Acc: 4880-16-4125
Acc Name: Chan Hua Chee

5. Treng Ching's class in Sri Damansara / Petaling Jaya (Chinese class)
Public Bank Acc: 6342-54-9318
Acc Name: Lim Treng Ching

6. Lay Khim's class in Bangsar
Maybank Acc: 1123-8014-7006
Acc Name: Khaw Lay Khim

7. Wei Wei's class in Cheras (Chinese)
Public Bank Acc: 4398-41-9732
Acc Name: Lee Wei Wei

8. Janette's class in Cheras (English)
Maybank Acc: 1122-5002-0292
Acc Name: Tang Sook Yee

9. Syn June's class in Penang
CIMB Bank Acc: 7020-10-7198
Acc Name: Gan Syn June


Step 2 - Key in YOUR NAME in the banking reference

Step 3 - Email the bank in slip with your name to bting@babywithbee.com

Step 4 - Register online with your details

I look forward to seeing you in class soon.

Warmly,
Baby With Bee Team
www.BabyWithBee.com

Class Details
Class Type *
Language *
Instructor / Location *
I would like to enrol in the class starting *
MM
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DD
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Mother's Details
Mother's Surname *
Your answer
Mother's Name *
Your answer
Mother's Birth Date *
MM
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DD
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YYYY
Mother's Handphone No. *
Your answer
Mother's Occupation *
Your answer
Mother's Hobby
Your answer
House Address *
Your answer
Mother's Email Address *
Your answer
Mother's Facebook ID *
Your answer
Birth Companion's Details
Birth Companion's Surname *
Your answer
Birth Companion's Name *
Your answer
Birth Companion's Birth Date *
MM
/
DD
/
YYYY
Birth Companion's Occupation *
Your answer
Birth Companion's Hobby
Your answer
Birth Companion's Handphone No. *
Your answer
Birth Companion's Email Address *
Your answer
Birth Companion's Facebook ID *
Your answer
Payment Details
Transaction Date *
MM
/
DD
/
YYYY
Transaction / Reference Number *
Your answer
Amount Paid (RM) *
Your answer
Pregnancy Details
Estimated Due Date *
MM
/
DD
/
YYYY
This is Baby number *
Baby's sex (if known)
Doctor's Name and Hospital *
Your answer
Have you attended any Childbirth Preparation Classes before this? *
(if yes, please state which childbirth class in the "Other" field)
Required
How did you find us? *
Required
How did you learn about HypnoBirthing? *
Your answer
Why have you chosen HypnoBirthing? *
Your answer
I agree to the following terms and conditions: (1) The 50% deposit is non-refundable unless medical proof can be shown. (2) Balance to be paid before the first class starts. (3) Any replacement classes will be chargeable at RM 250 per class. *
Required
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