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Event:
eLearn Childbirth Education
Contact:
Maternal Care Educators
812-842-4275
Description:
Once we receive your registration information and payment, you will receive a book in the mail. Log on to the book's website using the information found on the bottom right corner of the back cover. The online content gives you access to videos and handouts to complement the information found in the book. You will have 24/7 access to this site for 18 months.
Registration Information
*
indicates a required field.
First Name:
Last Name:
Date of Birth (mm/dd/yyyy):
Street:
City:
State:
Alabama
Alaska
Arizona
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Delaware
District of Columbia
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Hawaii
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Illinois
Indiana
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Maryland
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Michigan
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Mississippi
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New Hampshire
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New York
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code:
Phone:
I allow The Women’s Hospital to utilize my cell phone number to send me a reminder about the event. (Normal text message rates may apply.)
Email Address:
I allow The Women’s Hospital to utilize my email address to send me information on their educational programs and events.
Due Date:
Payment Method:
Credit Card
Voucher
Check
Employee
If using a voucher, enter the name of person that issued voucher:
If Women's Hospital employee, enter your ID:
Do you have/will you have a crib, pack and play, or bassinet for your baby to sleep?:
Yes
No
How did you hear about this class/event?:
Social Media (Facebook, Instagram, etc.)
TV or Radio
Mailing to my home
Physician Office
Community event (class, health fair, farmer’s market, etc.)
Oh Baby! App
Friend or Family
Payment
Amount
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