Register for "Birthing with Confidence (Series)"

Meeting Oct 12 - Oct 14

This class costs $60

Personal Details

First Name:

Last Name:

About Your Partner

Partner's Full Name:*

Address:*

Primary Phone:*

Alternative Phone:

Email: *

Date of Birth: *

Do you intend to breastfeed?: *

YesNoUndecided

About this Pregnancy

Due Date/Date of Birth:

Name of Physician and/or Midwife:

Payment Options

1. Cash/Check- Bring to first class.

2. Credit Card

Select Payment Method:

Credit Card Payments Only:

We will ask for your credit card information after your press "submit", below. Please complete everything on this page first.

MaineCard ID: If Paying Via MaineCare Only.

We'd like to offer you a scholarship if available. Complete this registration form, then call us at (207) 373-6500 to apply.

How did you hear about our classes?:

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123 MEDICAL CENTER DRIVE

BRUNSWICK, MAINE 04011

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PRIVACY PRACTICES

MAINE TOWNS WE SERVE

Accredited by The Joint Commission. Recognized as
a Magnet™ Hospital for exceptional nursing and patient care by the American Nurses Credentialing Center.

Learn more about Quality & Safety.

Register for "Birthing with Confidence (Series)"

Personal Details

About Your Partner

About this Pregnancy

How Did You Hear?

Payment Options