Class Registration - Maternal Health : Torrance Memorial Medical Center

I would like to register
in the following
Maternal Health Education class:

	Month	Day of the Week	Class Time

If you have special requirements, please type your message here:

So that we may better assist you please fill out the form: *= are required field

First Name: *	Last Name: *

Home Address 1: *	Home Address 2:

City: *	State: *	Zip Code: *

Email: *
Phone number: *
Alt Phone number: *
Fax number

My Due Date: *
OBs Last Name: *

Multiples

Yes

If Multiples, please choose

Twins

Triplets

Quads

Other

Registration in class is NOT confirmed until we receive all required information and payment in full. At that time, we will mail a class letter confirming your registration in the class. If you have questions or wish to follow up regarding an on-line revservation request you've already submitted, please call 310-517-4711 for assistance. HealthLine Representatives are available M-F, 8:30-5, or you may leave a message for call back 24 hours a days, 7 days a week.