Membership form 2019
Please complete the following fields in order to join Multiples Canterbury.
* Required
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:
*
Twins
Triplets
Quadruplets or more
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.
Yes
No
Not applicable
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).
1st year: $40 (new and expectant parents)
2nd-4th year: $15 (toddlers and preschoolers)
5th year onwards: $10 (school age multiples)
How would you like to pay?
*
Online banking
Cheque
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.
Yes
No
Emails:
*
I agree that Multiples Canterbury can email me information about news, new services, and events.
Yes
No
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