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WNY Mothers of Multiples - Member Registration
Please complete this member information/enrollment form to join as a club member. All information provided is kept confidential.
After completing the form, please submit your club dues to complete your registration.
Payment instructions are on the final page of this form. M
embership fees are $30 for first-year members, then $50 after year-one with opportunities to fundraise up to $20 of your dues.
We're excited to get to know you!
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* Indicates required question
Email
*
Your email
First Name & Middle Initial
*
Your answer
Last Name
*
Your answer
Full Facebook Name
*
Your answer
Street Number & Name
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
*
Please include area code
Your answer
What is your birthday?
MM
/
DD
/
YYYY
Relationship Status
Single
Married
Other:
Clear selection
Spouse's Name
(If married, enter spouse's name)
Your answer
Is there a family history of multiples (yourself, children's father, either family)?
Your answer
How did you hear about WNY Moms?
(Facebook, another member, some other way?)
Your answer
What are you hoping to gain from membership in the WNY MoMs club?
i.e. friendships, going to events, friends for your kids, etc.
Your answer
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