Online Membership Form

Please fill in the information requested and then click the submit button. One of our VPs of membership will contact you shortly. Dues are $25.00 per year (August 1 - July 31.) If you join after January 1 but before August 1 dues will be prorated to $20.00. Thank you for your interest in the West Chester Mother Of Twins & More Club.

Please provide the following information about your family:

Mother's Name
Mother's Birth Date
Father's Name
Address
City
State/Province
Zip/Postal Code
Home Phone
E-mail

Please provide the following information about your multiples. If you are currently pregnant with multiples please place your due date in the birth date area and continue on to the next section:

Name

Boy/Girl?

Name

Boy/Girl?

Name

Boy/Girl?

Name

Boy/Girl?

Birth Date

Please provide the following information about your other children:

Name
Boy/Girl
Birth Date
Name
Boy/Girl
Birth Date
Name
Boy/Girl
Birth Date

Do you work outside the home?

Where?

Full or Part time?

Hobbies or interests?

Do you have any special skills that you could offer to WCMOT&MC?

Are you interested in and/or helping out with (please select all that apply)

Playgroups	Serving on a committee	Fundraising
Philanthropic	Newsletter	Programs/Activities
Publicity	Refreshments

Name
Boy/Girl?
Name
Boy/Girl?
Name
Boy/Girl?
Name
Boy/Girl?
Birth Date

Online Membership Form

© 2008 West Chester Mothers Of Twins & More Club. Designed by NellKat Creations