Port Huron Event Registration

* required info

* Payment Option:

Your Date of Birth: *
Due Date:
Do you have Medicaid?	YesNo

Note: Only the expectant mother needs to be counted in the number of seats field below. Do not count your guest.
(example: 1 expectant mother and 1 support person = 1 seat)

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Number of Seats: *
Facility	Childbirth Education, Online Payment for Childbirth
Title	Breastfeeding 101
Event Information: *
Category	obstetrics, womens health
Event Date	9/12/2023
Cost:
Time:	5-7 P.M.
First Name: *
Last Name: *
Email Address: *
Address: *
City: *
State or Province: *
Postal Code: *
Country: *
Home Phone: *
Work Phone:
Comments:
Please note: All refunds, regardless of payment method, will be made by check. If you have a question, please contact HealthAccess event scheduling at 1 (800) 228-1484, Monday through Friday, 9 a.m. to 4 p.m.