Peoria Mothers of Twins (PMOT) Membership Form

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Please complete membership from.

Email *

Reason for Form *

New member

Renewal

Update Personal Information of Current Member

Other:

Full Name *

Date of Birth *

YYYY

Address: including city, state and zip *

Phone number *

Place of Employment

Significant Other/Partner Name

Significant Other/Partner Date of Birth

YYYY

Significant Other/Partner Place of Employment

Wedding Anniversary

YYYY

What kind of Multiples *

Twins- Fraternal

Twins- Identical

Triplets- Fraternal

Triplets- Identical

Triplets- Identical and Fraternal

Other:

Are you expecting multiples currently? *

Yes

If expecting, when is your due date?

YYYY

List the names, genders and ages of ALL children *

I hereby give my consent for PMOT to post pictures of me/my family that may be taken at PMOT functions. *

Yes

Would you like to be part of the PRIVATE PMOT Facebook group? *

Yes

If you would like to be added to the Facebook page, please provide your Facebook name exactly as it is shown.

I hereby give my consent for PMOT to add my information to the directory that is for paid/current members of PMOT. *

Yes

How did you heat about Peoria Mothers of Twins Club? *

Submit

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