Membership form 2022
Please complete the following fields in order to join Multiples Canterbury.
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Name (first name and surname): *
Address: *
Suburb:
City: *
Postal code: *
Phone number:
Cellphone number: *
Email address: *
Type of multiples: *
Estimated due date (40 weeks) of your multiples: *
If they have already been born, please insert their actual birth date and add their details in the next question.
MM
/
DD
/
YYYY
If your twins have already been born please add their names and genders.
Partner's name (first name and surname):
Please include contact details, if different to your own
Details of additional children:
Please include names (first name and surname), 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.
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).
Privacy: *
I give permission for the Multiples Canterbury to use my personal details for the membership database. Note your information will be kept in confidence in accordance with the Privacy Act 2020.
Magazine: *
I give permission for the Multiples Canterbury to include names in the member magazine (e.g. welcome to new members and babies, expectant parents and birthday lists). No contact details will be included.
Emails: *
I agree that Multiples Canterbury can email me information about news, new services, and events.
Is English your second language? What other language(s) do you speak? Please list.
Comment (please provide any additional details or questions you have):
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