Multiple Births Canada Direct Family Membership Form
This form is to be used by an individual or an individual family who does not belong to a Multiple Births Canada Affiliate Chapter. (Not for Chapter use.)
To avoid delays, please double-check information.
Please contact the office if you have any questions about membership or this form. 1-866-228-8824
New member or renewal
Please enroll me for the following
Name
List both parent if applicable
Your answer
Mailing Address
Your answer
Telephone Number
Your answer
Email Address
Your answer
Facebook Name
This is to help us approve your membership in private Facebook groups.
Your answer
Mutiples Arrival
Expectant Due date or Multiples Birthday
Your answer
Type of Multiples
For our records
Other Children
Number and ages
Your answer
Please enroll me in the following Support Networks
I am interested in being a volunteer for Multiple Births Canada
Payment options
Choose how you will pay
Multiple Births Canada respects your privacy. We protect your personal information and adhere to all legislative requirements with respect to protecting privacy. We do not rent, sell or trade our mailing lists. The information you provide will be used to deliver services, to keep you informed and up to date on the services and activities of Multiple Births Canada. If at any time you wish to be removed from any of these contacts simply contact us by phone at (866) 228-8824 or via e-mail at office@multiplebirthscanada.org and we will gladly accommodate your request.
Cheques can be mailed to MBC P.O Box 352 Lefroy, Ontario L0L 1W0
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