JEYARNI GENTLE BIRTH METHOD

Booking Form Jeyarani Gentle Birth Method Self-Hypnosis and Visualisation Course Viveka, 27a Queen’s Terrace, St John’s Wood, London NW8 6EA Course dates: 15th September,13th October and 10th November 2008 For future dates and venue please call 020 8530 1146 The course runs for four consecutive Mondays from the start date
£240		5.00pm
Course commencing:

	15 September 2008
	13 October 2008
	10 November 2008


Name:

Partner 's Name:

Home Address:


Contact Home Phone No.:

Mobile No.:

Work Phone No.:

Email Address:

Expected Date of Delivery:

Gestation at start of course:

Which hospital are you booked with or do you plan a home birth?

If this is not your first birth, please give details of your previous birth experience(s)


Have you, or will you be attending any other birth education classes during this pregancy? If yes, please give details?

Please make all cheques payable to Gentle Birth Method Ltd and post them to:
Gentle Birth Method Ltd. 34 Cleveland Road South Woodford London E18 2AL Tel: 020 8530 1146