PLEASE PRINT
| workshop, class or service | cost | amount enclosed |
balance owing |
date and location |
| Childbirth Preparation ...with a difference |
$150.00 | _______ | _______ | .................. |
| childbirth preparation --Private Classes |
$200.00 | _______ | _______ | ................. |
| Birth Planning to Empower and Inspire |
single $35.00 couple $60.00 |
_______ | _______ | ................. |
| breastfeeding positive (3 hours) |
$45.00 | _______ | _______ | ................. |
| Dads can DO-oula it! -birth partner preparation |
couple $60.00 | _______ | _______ | ................. |
| Subtotals | _______ | _______ | _______ | |
| 15% off (2 workshops) | -_______ | _______ | _______ | |
| OR 20% off (3 workshops) | -_______ | |||
| Subtotals | _______ | _______ | _______ | |
| Childbirth Doula Services | $500.00 | _______ | _______ | (minimum deposit: $100) |
| Postpartum Doula Services x _____ hours |
$20.00/hour = _______ |
_______ | _______ | |
| Belly Cast when included with doula services |
$60.00 | _______ | _______ | A charge of $20 will apply to all NSF returned cheques. |
| Belly Cast without doula services | $90.00 | |||
| Totals | _______ | _______ | _______ |
Name: __________________________ Email:_________________ Phone:_________________
Address:_________________________
City:____________________________
Postal code:_______________________
PLEASE MAIL COMPLETED FORM to:
Jodi Hinds c/o Birth Positive
20 Weston St, London ON N6C 1R1