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Name *
Email *
Name of Birth Support  Attending Class With You & Relationship to You
Phone Number *
Estimated Due Date *
Birthing Location *
Individual Classes-Please Choose All That Apply *
Do you desire to have a private class, create your own group class or have a virtual class? *
If you would like to create a in-person or virtual class, which day/time do you prefer? *
Payment Options *
Please email me so I can make sure your form processed at If you have any questions, please don't hesitate to contact me! -Rhonda Fellows
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