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Membership form 2024
Please complete the following fields in order to join Multiples Canterbury and its associated satellite groups (Nelson, Blenheim, Timaru, Ashburton, West Coast).
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* Indicates required question
Name (first name and surname):
*
Your answer
Address:
*
Your answer
Suburb:
Your answer
City:
*
Your answer
Postal code:
*
Your answer
Phone number:
Your answer
Cellphone number:
*
Your answer
Email address:
*
Your answer
Type of multiples:
*
Twins
Triplets
Quadruplets or more
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.
Your answer
Partner's name (first name and surname):
Please include contact details, if different to your own
Your answer
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.
Your answer
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.
Yes
No
Not applicable
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).
1st year: $40 (new and expectant parents)
2nd-4th year: $15 (toddlers and preschoolers)
5th year onwards: $10 (school age multiples)
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.
Yes
No
Magazine:
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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.
Yes
No
Emails:
*
I agree that Multiples Canterbury can email me information about news, new services, and events.
Yes
No
Is English your second language? What other language(s) do you speak? Please list.
Your answer
Where did you find out about Multiples Canterbury?
*
Multiples Canterbury website
Multiples Canterbury Facebook page/group
Multiples Canterbury Instagram
Multiples Canterbury brochure/poster
Multiples NZ website
Multiples NZ Facebook page/group
Midwife or other health professional
Friend/family
Natural Parent magazine, website, Facebook
Other:
Comment (please provide any additional details or questions you have):
Your answer
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