New Member Inquiry Form
Please fill out this form if you are interested in becoming a LAPOM member, so that we can send you information about our group.
Your last name *
Your first name *
Street address *
City *
Zip Code *
Email *
Spouse/partner's name *
Your birthday *
Spouse/partner's birthday *
Phone number *
Your children's names from oldest to youngest (If pregnant and no other children, write "expecting twins, expecting triplets, etc".) *
Your children's birthdays/due date from oldest to youngest in M/D/YR form *
What is your facebook profile name, if different from your name listed above? If it is the same, write "same". *
What is your PayPal account name, if different from your name listed here? If the same or if you don't have PayPal, write "NA". (PayPal is often used to pay dues.) *
Photo release: *
Required
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