Course Registration Form

Course Registration Form

Sign up for our courses and complete your registration with payment. Please read and agree to our terms and conditions before submitting.
Name (Mum/birthing person)*

First NameLast Name
Age *
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone number*
Please enter a valid phone number.
Email address*
example@example.com
Occupation
First or subsequent birth experience*

First birthSubsequent birth
Estimated Due Date*

MonthDayYear
Date
Name of your Lead Maternity Carer
Name (Birth Partner)

First NameLast Name
Relationship to Mum/birthing person
First or subsequent attendance at a birth

First attendanceSubsequent attendance
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone number
Please enter a valid phone number.
Email address
example@example.com
Occupation
Where did you learn about Hypnobirthing?
If seletected 'Other' please specify*
What interests you most in the course?
How are you hoping it will help?
Anything you think it would be helpful for me to know?
How did you hear about Anna’s Birth Services?
If seletected 'other' please specify*
Would you like a follow-up via zoom with Anna at full term?

YesNo
Birth Course Payment Details

The deposit to secure your place is $103.20 (includes Stripe processing fees). The full course fee is $495. You can choose to pay the remaining balance in one invoice ($395) or split it into two instalments ($200 and $195, two weeks apart). Invoices will be emailed after registration.

My Products*

Mind and Body Birth Prep | 14th & 15th Feb 26' (full weekend)Course 1 (full weekend) 14th and 15th February 2026

$103.20NZD Quantity

Mind and Body Birth Prep | 11th & 18th Apr 26' (x2 consecutive Saturdays)Course 2 (x2 consecutive Saturdays) 11th and 18th April 2026

$103.20NZD Quantity

Mind and Body Birth Prep | 20th & 21st Jun 26' (full weekend) Course 3 (full weekend) 20th and 21st June 2026

$103.20NZD Quantity

Mind and Body Birth Prep | 15th & 22nd Aug 26' (x2 consecutive Saturdays)Course 4 (x2 consecutive Saturdays) 15th and 22nd August 2026

$103.20NZD Quantity

Mind and Body Birth Prep | 17th & 18th Oct 26' (full weekend)Course 5 (full weekend) 17th and 18th October 2026

$103.20NZD Quantity

Mind and Body Birth Prep | 5th & 12th Dec 26' (x2 consecutive Saturdays)Course 6 (x2 consecutive Saturdays) 5th and 12th December

$103.20NZD Quantity

Total

$0.00NZD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Select your course dates*

14 & 15 Feb 2026 – Full Weekend11 & 18 Apr 2026 – Consecutive Saturdays20 & 21 Jun 2026 – Full Weekend15 & 22 Aug 2026 – Consecutive Saturdays17 & 18 Oct 2026 – Full Weekend5 & 12 Dec 2026 – Consecutive Saturdays
How would you like to pay the remaining balance?*

One invoice: $395Two instalments: $200 then $195 (two weeks apart)
Should be Empty:

Course Registration Form

Birth Course Payment Details