Register

*The information you provide to us is confidential and will not be shared with any third parties*

Registration Form

1. Your Name(required)
2. Your Email(valid email required)
3. Your Occupation
4. Your Birthdate
5. Partner's Name
6. Partner's Email(valid email required)
7. Partner's Occupation
8. Your Phone Number(required)
9. Alternate Phone Number
10. Mailing Address with zip
11. Your Due Date(required)
12. Preferred Class: Select one from list below. Lanell's Class Marcela's Class No Preference
13. What is your preferred class date?
14. OB or Midwife Name(required)
15. Doula Name
17. Birth Postpartum Both
18. If you have other children, how old are they?
19. Describe any complications you may have had in previous deliveries.
20. Do you have any special needs? If so, please explain.
21. Type in the characters you see here:
22. *Office Use Only*

 

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Payment Options…

1. By mail.

If you’re taking Lanell’s class, mail a check payable to:

Lanell Coultas
1401 Ridgehaven Drive
Austin, TX 78723

- or -

If you’re taking Marcela’s class, mail a check payable to:

Marcela Billig
5310 Fort Clarke Drive
Austin, TX 78745

2. Pay with Paypal.

Paypal.com is an easy and secure way to send money over the internet.

Email for complete instructions on how to pay using your credit card via paypal.com. An extra, nominal fee applies for using this service.

Policies & Procedures…

• Your spot is reserved with your full payment.
• No part of the fee is refundable, even for missed classes, early delivery, or a change in your plans.
• Upon receiving your registration, we will send you further details on how to prepare for these unique classes!