Form Test A Better Birth Payment & Signup The initial form clients see on the A Better Birth page. "*" indicates required fields name* First Last phone*email* partner name email care provider name* care provider (name of midwife, doctor)when is your due date?* Month Day Year how did you find us?* Payment InformationPayment Preference*Full Payment $180.00Deposit $90.00Choose Class DateEarly registration is recommended as classes fill quicklyJAN 14: 930-430PM ( SOLD OUT )FEB 11: 930-430PM (with Kathleen) FEB 25: 930-430PM (with Elise) MAR 11: 930-430PM (with Kathleen) MAR 25: 930-430PM (with Elise) Total Credit Card Cardholder Name Card Details