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: : 6th September; 4th October, November 1st and November 29th 2010 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:

	6th September 2010
	4th October 2010
	1st November 2010
	29th November 2010


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