Listing Reservation Form

Disclaimer: The Pregnancy Connection Directory reserves the right to reject any listing it considers to be inappropriate from its website or publications.

Listing Type:

Listing Categories (Please highlight all you wish to be listed under):

To highlight more than one listing per category, use ctrl+click (PC).
To un-check a listing, use ctrl+click (PC).

Bodywork/Natural Therapies:

Breastfeeding:

Childcare:

Doulas:

Education:

Fitness:

For Kids and Families:

Health Care/Mental Health Care:

Support/Resources/Advocacy:

Other Services:

Number of listing categories requested:

Contact Information:

First Name:

Last Name:

Credentials: Business Title:

Business Name:

Mailing Address:

Mailing Address 2:

City: State:

Zip Code:

Business Phone: Fax Line:

Cell Phone: Home Phone:

Email Address:

Website Url:

If you are purchasing the Expanded or Premium listing subscriptions, please provide a description (up to 75 words in length) of your business or services. (We reserve the right to edit for clarity or length)

Description:

I am a recognized agency, support group, or non-profit and am eligible for a 20% discount. (Check only if applicable)

Acknowledgment: In order to process your subscription, please confirm that the information you have entered is both accurate and complete and that you give permission for the information to be used in the following ways:

Entered into The Pregnancy Connection Directory database
Posted on our website
Entered into an e-mail database for the purposes of communicating information about the The Pregnancy Connection.

Your information will not be shared in any other way without your explicit agreement.

Agree Disagree

Additional Comments:

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Listing reservations will be reviewed within five business days of receipt. Upon approval, you will receive a notification via e-mail along with payment instructions.

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You may also download and print a registration form and mail in with your check or money order made out to OmMama, LLC to the following address:

OmMama/Directory
2203 West Grace St
Richmond, VA 23220

Download Listing Reservation Form (.pdf)

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If you have any questions, please email Leslie Lytle at info@OmMama.com or call me at 804-612-6366.