Expectant Parent Education Registration Form    
All classes are FREE. Seating is limited, so registration is required. You may register for as many classes as you like with this form.

You may register via the Internet.  Or, to ensure the privacy of your personal information, you may print this form and mail it instead to the address at the bottom of the page.
Name: *      * = Required
Street Address: * 
City: *    State:  *     Zip:  * 
Phone(home): *    Phone(work): 
E-mail:    
Doctor:    
Due Date:    
 (To choose a class, select it in the "Classes" list and click "Add".)
Classes:   
Selected:   
  (To remove a selected class, select it and click "Remove".)

     Classes:     
Click “Register” to register via the Internet. If you prefer, you may print this form and mail it to:
Maury Regional Medical Center
Attention: Childbirth Coordinator
1224 Trotwood Avenue
Columbia, TN 38401