Premium Membership
Before you join our tribe, tell us about you
Your Name
*
First Name
Last Name
Partner's Name
*
First Name
Last Name
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us ?
Please Select
Friends
Midwife
Hospital
Internet
Others
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Next
What Type of Multiples
*
Please Select
Twins
Triples
Quads
Identical or Fraternal ?
*
Please Select
Identical
Fraternal
Expected due date (or birthday if already there )
*
-
Day
-
Month
Year
Date
Names of multiples
Names and ages of other children
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Next
Do you want to be paired up with a buddy? (Another local multiple mum)
Yes
No
Do you want to be a buddy?
Yes
No
Would you be interested in helping the committee?
Yes
No
Back
Next
Join me to the Tribe !
*
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( X )
Premium Membership - Multiples BOP: Yearly - $35
(
$35.00 NZD
$
35.00
NZD
for
1 year
)
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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