HMM Directory Listing Form
Information for HMM Directory. This includes HMM News Listserv and Newsletter option. Note that listing forms are also available in the Meeting Library.
Email address *
Name 1 *
Your answer
Nickname
Your answer
Cell Phone
Your answer
Birth Date
MM
/
DD
/
YYYY
Quaker Membership
Home Address, Phone, and Mailing Lists
Shared household information and Mailing List choices
Address Line 1 *
Your answer
Address Line 2
Your answer
City, State, ZIP Code *
Your answer
Home Phone
Your answer
How did you hear about us?
Your answer
HMM Newsletter
Listerv (HMM-News) *
Second Principal Household Member
Name 2
Your answer
Name 2 Nickname
Your answer
Name 2 Cell Phone
Your answer
Name 2 Birth Date
MM
/
DD
/
YYYY
Name 2 Email Address
Your answer
Name 2 Quaker Membership
Name 2 Directory Listing
Children
Please include full name including last name. Include nickname in any in parentheses.
Child 1 Name
Your answer
Child 1 Birthdate
MM
/
DD
/
YYYY
Child 2 Name
Your answer
Child 2 Birthdate
MM
/
DD
/
YYYY
Child 3 Name
Your answer
Child 3 Birthdate
MM
/
DD
/
YYYY
Additional Children (Name, Birthdate, Email)
Your answer
If this is a modification to an existing listing, please describe what has changed.
Your answer
Comment
Your answer
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