Membership form 2019
Please complete the following fields in order to join Multiples Canterbury.
Name: *
Your answer
Address: *
Your answer
Suburb:
Your answer
City: *
Your answer
Postal code: *
Your answer
Phone number:
Your answer
Cellphone number: *
Your answer
Email address: *
Your answer
Type of multiples: *
Estimated due date (40 weeks) of your multiples: *
If they have already been born, please insert their actual birth date.
MM
/
DD
/
YYYY
Partner's name:
Please include contact details, if different to your own
Your answer
Details of additional children:
Please include names, dates of birth, and genders of any additional children (and of your multiples' names, if already known). Tip: Shift+Enter to create a new line for each child.
Your answer
Would you like a buddy? *
New and expectant parents only: this is a current member who would act as a support person and point of contact for you.
What level of membership would you like? *
The appropriate membership fee should be paid directly into the club account: Westpac 03-1702-0024511-00 (include your first name and surname in the reference and particulars fields, to ensure we match payments correctly).
How would you like to pay? *
Privacy: *
I give permission for the Multiples Canterbury to use my personal details for: the membership database; emailed event updates; magazine information (such as welcome to new members and babies, expectant parents and birthday list) and photographs taken at events for publication in the magazine & members only areas of the website. Note your information will otherwise be kept in confidence in accordance with the Privacy Act 1993.
Emails: *
I agree that Multiples Canterbury can email me information about news, new services, and events.
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