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
$10 Membership including access to Multiple Moments
Just looking for information. Please contact me.
List both parent if applicable
This is to help us approve your membership in private Facebook groups.
Expectant Due date or Multiples Birthday
Type of Multiples
For our records
Number and ages
Please enroll me in the following Support Networks
Higher Order Multiples
Loss of Multiples
Contact me with more information about these networks
I am interested in being a volunteer for Multiple Births Canada
Maybe- give me more information
Choose how you will pay
PayPal Button on the MBC website - Be a member page
Cheque mailed to the office listed below
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
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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