Childbirth Education Online Registration Question Title * 1. Email address OK Question Title * 2. Name OK Question Title * 3. Date of Birth OK Question Title * 4. Address, State and City OK Question Title * 5. Pregnancy Weeks OK Question Title * 6. Phone Number OK Question Title * 7. Please select the date and class option you prefer October - Online October - In-person November- Online November - In-person December - In-person December - Online January - In-person January - Online OK Question Title * 8. Type of Payment Medicaid - $0 Cash - $35.00 Check - $35.00 OK Question Title * 9. Medicaid Number OK DONE