Class Registration Form

For online registration, please register before 12:00 am the day of the class.

First name   M. I. (optional)  
Last name
Home phone #
Work/cell phone #
E-mail address
Baby's birth or due date    (MM/DD/YY)
Date(s) of Class (see below for times)    (MM/DD/YY, MM/DD/YY...)

Select one or more classes:
Breastfeeding Preparation - 1st and 3rd Wednesday 11:30 - 1:00, FREE
Breastfeeding & Weaning Toddler - 1st Friday 11:30 - 1:00, FREE
Breastpump Basics - 2nd and 4th Wednesday 11:30, FREE
Return to Work - 2nd and 4th Wednesday 11:30 - 1:00, FREE
Breastfeeding the Older Baby (4 - 11 mos) - Last Thursday 11:30 - 1:00, FREE

Please remember date and time, as registration is sent via e-mail (no electronic confirmation).

Please only hit the submit button once. To confirm e-mail has been sent, open your e-mail client (Outlook, Eudora, etc.) and check the "Sent Mail" folder for an e-mail with subject "Class Registration."