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Contact Detials
*
Indicates required field
Your Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Ethnicity
*
Mobile
*
Occupation
*
Email
*
*Please select an email address that will be accessible during any maternity leave.
Partner's Name
*
First
Last
Partner's Gender
*
Male
Female
Partner's Date of Birth
*
Partner's Ethnicity
*
Partner's Occupation
*
Partner's Email
*
Address
Address
*
Street Address, Suburb, City, Post Code
Postal Address
*
*If your postal address is differnt.
Membership
Membership Type
*
Full Membership Package - $325
Antenatal Membership Package - $295
Postnatal Membership - $190
More information on membership types
here
.
Course Code
*
AN2205
AN2206
AN2207
AN2208
AN2209
AN2210
AN2211
AN2212
Postnatal Membership
Other
Payment
Payment Options
*
Bank Transfer
PayPal (also includes debit & credit card payments)
Payment information will be displayed on the next page after submitting your membership form.
Antenatal
Your Due Date
*
Lead Maternity Carer
*
Home or Hospital?
*
*If hospital, which one?
Are there any special circumstances about you or your antenatal history that you would like us to be aware of (miscarriages, previous pregnancies, etc)? This information will be strictly confidential to our Childbirth Education Team.
Comments
*
How did you hear about Parents Centre?
*
Lead Maternity Carer/Dr
Friend/Family
Facebook
Internet (Google)
Advertising (Print, Email, etc)
Other
Do you wish to receive offers from carefully screened companies whose products or services we think you may be interested in?
*
Yes
No
Are you interested in volunteering for Parents Centre now or in the future?
*
Yes
No
If interested, please indicate when you would like to be contacted.
*
e.g - 1 month, 3 months, 6 months
This information will be used for the purpose of Parents Centre membership and courses and the compilation of national statistics. Individuals may view and correct information about themselves by contacting the membership officer for their Centre.
Please note, your membership will be activated about approx 2 weeks prior to the commencement of your course to ensure you can maximise our membership benefits when you have your child.
If you haven't heard back from us within a few days, please check your junk/spam email folder as our replies can sometimes end up in there in error.
Cancellations
– A minimum of 28 days notice prior to the start of a course is required. Cancellations after this date will not be refunded. Cancellations prior to 28 days will incur a $25 administration fee. If you are no longer wishing to attend antenatal classes please contact us to advise.
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