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 20% deposit to

MAYBANK Account - Baby With Bee Education Sdn Bhd
Account number - 5127-8108-5254

Step 2 - Key in YOUR NAME in the banking reference

Step 3 - Email the bank in slip with your name to info@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 *
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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
House Address *
Your answer
Mother's Email Address *
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 Handphone No. *
Your answer
Birth Companion's Email Address *
Your answer
Payment Details
Transaction Date *
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DD
/
YYYY
Transaction / Reference Number
Your answer
Amount Paid (RM) *
Your answer
Pregnancy Details
Estimated Due Date *
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DD
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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 20% 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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