Interested in Joining?

PLEASE FILL IN THIS FORM, PRINT IT OUT, AND THEN FOLLOW THESE DIRECTIONS FOR SUBMITTING YOUR FORM: EASTERN HILLS MOTHERS OF TWINS OR MORE CLUB, CINCINNATI 2004-05 REGISTRATION FORM

Please complete and mail the registration form to: EHMOTC Treasurer, 2590 Royal Court, Burlington, KY 41005, or bring it to the next meeting.  Dues of $22.00 are needed to complete your registration. Mail check with form or bring to your first meeting! **JOIN AFTER JANUARY 31, 2005, AND DUES ARE PRORATED TO 15.00 ** Your prompt attention is needed to continue to receive newsletters, mailings or attend the members' pre-sale.         Please makes checks payable to: EHMOTC

NAME:     SPOUSE:     ADDRESS:     AREA OF TOWN:     CITY:     STATE:        ZIP CODE:   PHONE (HOME):     E-MAIL:     BIRTHDATES:     (month/day) Yours:     Spouse's:

CHILDREN:    (list all, beginning with oldest) NAME: SEX (M/F): BIRTHDATE (mo/day/yr):

Date you joined ehmotc  YES NO    Do you need a new name tag?  YES NO    Have you held a position or served on a committee with EHMOTC? If yes, please list all positions or committees and the year you served:                                    YES NO    Is anyone else in your family a twin?                                  If yes, who?         If you are expecting, when is your due date?   Are your Twins:   Fraternal   Identical  Unknown  YES NO  Do you work outside the home?   Full Time Part Time   OCCUPATION:    YES NO  Do you or your children have any special needs?  YES NO  Are you interested in participating in a playgroup?  YES NO  Are you interested in participating on a committee?        Do you have any hobbies? (please list)  YES NO  Do you belong to any other MOTC Groups?                                  If yes, who?   YES NO  Did you pay your National dues to the other MOTC group? Please return completed registration form with check (payable to EHMOTC) to:                                                     EHMOTC Treasurer                                                              2590 Royal Court                                                        Burlington, KY 41005 For Treasurer's Use Only: Date Paid: ___________________ Check #: ____________ Cash: _____________ Treasurer _________ National Representative _________ Membership __________ (Newsletter: Directory _______ Database ______ Email ______ Labels ______ Membership List _____)