TPOMBA new Membership Form
Fill out the form and click here to Print        back

Mother's Surname
Mother's First Name
Father's Surname
Father's First Name
   
Address:  
Street Number Apt.#
City
Province Postal Code
   
Telephone:
e-mail:
May we send you your new members package to this email address?


Child/Childrens' Information Updates Only
(include multiples and siblings)

Name
Sex
(m/f)
Identical/
Fraternal
Birth/
Due Date


Type of Membership (for more detailed information on membership benefits please contact one of the P.O.M.s = Parents of Multiples, Coordinators)

Regular $40 Regular 2 years $70 Bulletwin Subscription Only $25
To find the POM's group next to your home please select the first 3 digits of your postal code
You belong to:

Waiver: I agree that I will not hold the Toronto Parents of Multiple Births Association
(TPOMBA) responsible for any injuries that may occur to me or any family member
in conjunction with any TPOMBA event. I agree not to use any information pertaining
to TPOMBA or its members for business or solicitation.

Signature:____________________________________ Date: _____________

Make Cheque payable to: Toronto Parents of Multiple Births Association
Mail Cheque and Application Form to:
Membership Coordinator
TPOMBA c/o Regional Women's Health Centre
Sunnybrook & Women's College Health Sciences Centre
790 Bay St.
Toronto, Ontario M5G 1N9

Please contact membership@tpomba.org if you have not received your new membership card in 4 weeks.