Conscious Birthing Austin | Register for Class






	Always we hope someone else has the answer. Some other place will be better. Some other time, it will all turn out. This is it. No one else has the answer. No other place will be better. And it has already turned out. At the center of your being you have theanswer; you know who you are and you know what you want. There is no need to run outside for better seeing. Nor to peer from a window. Rather abide at the center of your being; For the more you leave it, the less you learn. ~ Lao-tsu

To Register for Classes... Please fill out the form below and choose one of the two payment options. (the information you provide to us is confidential and will not be shared with any third parties)

Your Full Name:
Occupation:
Your Birth Date:

Partner's Full Name:
Occupation:
Partner's Birth Date:

Expected Due Date:

Preferred Class Location:	North South

Preferred Start Date:
Home Phone:	( )
Other Phone:	( )

Mailing Address w/ zip
Email Address:

Physician/Midwife:
Doula: birth, postpartum, or both:

Other Children:
Name:
Birth Date:
Name:
Birth Date:
Name:
Birth Date:


Please list any complications or interventions with previous pregnancies or labors: (miscarriage, ectopic, pre-eclampsia, multiples, epidural, forceps, cesarean, episiotomy, etc.)



Do you intend to take a separate breastfeeding class?
Yes No	If yes:
When:
Where:

How did you hear about our childbirth classes?


Do you have any special needs with regard to your learning style that we should know about?


Please indicate anything else you would like us to know:


Payment Options... 1. By mail. If you're taking the NORTH class, mail a check made payable to: Lanell Coultas 1401 Ridgehaven Drive, Austin, TX 78723 - or - If you're taking the SOUTH class, mail a check made payable to: Marcela Billig 5310 Fort Clarke Dr Austin, TX 78745 2. Pay with Paypal. Paypal.com is an easy and secure way to send money over the internet. Email for complete instructions on how to pay using your credit card via paypal.com. An extra, nominal fee applies for using this service. Policies & Procedures... Your spot is reserved with your full payment. No part of the fee is refundable, even for missed classes, early delivery, or a change in your plans. Visit the Resources page to learn how to prepare for the classes.