APPLICATION
Please complete the form for review by our group administrators.

 
Member Information
 
(* = Required Information)
* First Name:
* Last Name:
Spouse/Partner First Name:
Spouse/Partner Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip Code:
* Email:
* Home Phone:
   
Mobile Phone:
   
Work Phone:
   
* Password:
* Confirm Password:
 
Parenting Information
 
* Due Date:
      (If pregnant)

Number expecting (if pregnant):

* Child Information (Name,Birthday,Gender):
  1. Name:
  Month & year of birth:
       MaleFemale
  2. Name:
  Month & year of birth:
       MaleFemale
  3. Name:
  Month & year of birth:
       MaleFemale
  4. Name:
  Month & year of birth:
       MaleFemale
  5. Name:
  Month & year of birth:
       MaleFemale
  6. Name:
  Month & year of birth:
       MaleFemale
 
Personal Information
 
WCMOTC would love to know a little more about you so that we can plan events/programs that suit your interests. Thanks!
 
* Can your phone number be published in the WCMOTC listing?
Yes   No  
For emergency Purposes
Maiden Name
Member birthday (for announcements in the newsletter) (mm/dd)
If you want your children's/stepchildren's birthday(s) to be announced in the newsletter, please include the exact date of their birth. (Please indicate what birthday goes with which child). Include any children not living with you.
* What week did you deliver? (Round to the nearest whole week)
* Were you on bed rest?
Yes   No  
If yes, what week of your pregnancy did you go on bedrest?
* What type of birth?
If vaginal, was it VBAC?
* Where did you hear about us?
Any ideas for meeting discussion topics or speakers?
Any ideas for club events or activities?
Would you be interested in helping with any of the following? Check all that apply
Clothing sale set-up
Fundraising
Special events
Publicity
Membership
Are there any special circumstances with your pregnancy, delivery or your twins that you would be willing to share with other members? (Bed rest, NICU, breastfeeding?)
Your employer and employer's phone number
Husband's employer and phone number
Emergancy contact
* Can your email address be published in the WCMOTC listing?
Yes   No  
* Did you breast or bottle feed?
* Are your twins
* Can your address be published in the WCMOTC listing?
Yes   No  
 
 
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