Membership

MOTC Queens - New Member Form 2011-2012

Welcome. Thank you for taking a few minutes to complete this information form. We are interested in what you hope to learn and what activities interest you and your family.

Name	Spouse/Partners Name
Occupation	Occupation
Mailing Address

Home number	Cellular
E-Mail address

My children are

Twins

Triplets

They are

Identical

Fraternal

Birth/Due date:________

Twins

Triplets

They are

Identical

Fraternal

Birth/Due date: _______

Multiples Names
How did you hear about us?	Friend / Family	Internet	Dr. /Hospital	Newspaper

Please include the following for our newsletter Birthday/Anniversary columns:

Your Birthday	Your Anniversary
Other Children: Name / Birthday

I would like additional information on how to get involved in the following areas:

new members support	newsletter	web site	publicity
holiday party planning	dinners out	fundraising	family day trips
playgroups	social walks	fitness walks	equipment exchange
national / state clubs	hospitality	club photography	club historian
domestic welfare	meeting programs	chaplain	____________________

Mothers of multiples are welcome to join us for 3 months prior to payment of dues. Expectant MOM's are welcome throughout their pregnancy. Annual dues are $25. Dues are collected at monthly membership meetings, or can be mailed to our treasurer. Dues can be paid by cash or checks made payable to "MOTC Queens." Members benefit from also belonging to the National Organization of Mothers of Twins Clubs and the New York State Organization of Mothers of Twins Clubs. If there is additional information you would like to request or share, please use the back of this page. We look forward to meeting you.