Event Registration
Use the form below to complete your registration for this event.
*Indicates required fields.
Your Event
Back to Work Breastfeeding Success
Time: 6:00 PM - 7:30 PM
Cost: Free
Event Date
*
Please Select
February 5, 2026
April 9, 2026
June 8, 2026
Ticket
*
Please Select
General (Free)
Your Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of Birth:
*
Free classes are for patients delivering at CoxHealth only. Are you delivering at CoxHealth?
*
Yes
No
Who is your OB provider?
*
Due date:
*
Name of support person attending with you:
*
In-person attendance allows for the best experience. How would you like to attend this class?
*
Please Select
In-person
Virtual
Submit
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