For a positive change to your life





Course Enrolment Form

 Mother's name:






 Home telephone


 Mobile/Work Phone


 Email address



 Birthing Companion Name:



 Relationship: (Spouse, partner, etc)



 When is baby expected ?


 Planned place of birth:


 Name of Community Midwife:


 Which hospital are you booked to have care with:


 I wish to enrol for the HypnoBirthing® class beginning




Please complete this form in full and send with a £50 deposit made payable to P Cowan at

Philippa Cowan, 34 Kingsley Walk, Ely, Cambridgeshire, CB6 3BZ

Email- with any further enquiries.

The remaining balance is payable in instalments with half paid at class 2 and the final balance at class 4.