2019 Napa Moms Membership Renewal Form
Thank you for joining or renewing your membership with Napa Moms! Everything with an asterisk* is mandatory, there is a link to a totally optional survey at the end that will be completely anonymous and will be used for us to get info on metrics for potential partners.
Are you a new or returning member?
Brand new: (please request to join here:
Renewal after a while out of the group
First and Last Name
Name used for Facebook
PayPal name (the one you will use to pay dues)
How many children do you have? Please include baby if you are pregnant currently
What ages are your child(ren)? Check all that apply
6 months-2 years
school age (5+)
How did you hear about Napa Moms?
Are you interested in hearing more about volunteer opportunities within Napa Moms?
No thank you
Holly Bloom Memorial Scholarship
Endowed by the Hartford-Sharma Family to provide access to Napa Moms for all
Yes, I need my dues covered by the Holly Bloom Memorial Scholarship
No thank you, I will pay my dues
I understand that my child's/children's participation in any Napa Moms activity or meeting is completely voluntary on my part, and thereby give my permission for them to join in those activities. I shall hold Napa Moms, its volunteers and representatives, and/or providers of the meeting/activity location free from liability or responsibility for any accident, illness or injury that occurs during or as a result of those activities. I accept that the final responsibility for my safety and that of my child/children, rests with me. This applies to any and all future meetings or activities I attend.
A copy of your responses will be emailed to the address you provided.
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