Membership Application/Renewal Form  
 

       

Address1:       Check if new address

Address2:  

City/Town:  

-

Home Telephone.:  () -   Check if new phone.

Work Telephone:    () -   ext:

Email Address:   Check if new email. 

You will receive confirmation in your email and an invitation to join the MMOTA-Founding Members Only Area. 

To access the Members-Only Area, you will need internet access.  If you don't have internet access, please check here.

Member's Date of Birth:// (mm/dd/yyyy e.g. 12/31/1967)

Occupation:

Full Time/Part Time? 

 

Partner's Occupation:

Your Children

Type of Multiple(s):    

 If Other, Enter Type:

1st Set Date of Birth or Due Date:  // (mm/dd/yyyy e.g. 12/31/1967)

2nd Set Date of Birth or Due Date: //

Fraternal/Identical?

Names of Multiples:

Multiple 1:

Multiple 2:

Multiple 3:

Multiple 4:

Multiple 5:

Multiple 6:

Names of Siblings:

Sibling 1:

Sibling 2:

Sibling 3:

Sibling 4:

Sibling 5:

Sibling 6:

 

Membership

 

What MMOTA activities would you and your family like to participate in?

Monthly Meetings
 Other: 

Are there any programs or activities you would like to help MMOTA organize or sponsor?

Membership Dues:

Our dues cover the year from July 1 to June 30.

     $30.00 for full year for one set of twins from now until next June 30.

     $12.50 for two sets of twins from July 1 to June 30.

     $12.50 for moms of triplets, quads or higher-order multiples (July 1 to June 30)

     $15.00 Half year membership (January 1 to June 30, for new members only)

Paying by credit card or check?

     Credit Card (please submit this form and go to the next page for credit card payment)

     Check (please send a check to the address below).

 

Please send your check made payable to "MMOTA-Founding Chapter" to:

MMOTA-Founding Chapter

c/o Nancy Zimmer

17 Beacon St
Wilmington, MA  01887 

 

Please press submit and go to the next form to send a check or pay by PayPal.