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Prepared Childbirth and Breastfeeding Class Registration

Please enter your information. Starred fields are required.

Date of class(es) you want to register for?
First Name:* 
Last Name* 
Street Address:* 
City, State, Zip code:*  -  
Phone Number*() - ext.   
E-mail Address:
Date of Birth*  
Delivery Date:*  
Doctors Name:* 
Support person's name:
Will your support person attend with you?

Are you a UMMC employee?*
Are you expecting multiples?*
Have you had a previous C-Section?*
Are you planning to breastfeed?*
Name of hospital where you plan to deliver:* 
Can we contact you by e-mail about future events, opportunities and other program information?*