Submit a Membership Application
Mom's Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mom's Birthday (mm/dd)
*
Partner's Name
First Name
Last Name
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Names and Birthdays of Children
Name
*
First Name
Last Name
Child's Birthday
*
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Month
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Day
Year
Date
Name
First Name
Last Name
Child's Birthday
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Month
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Day
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Date
Name
First Name
Last Name
Child's Birthday
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Month
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Day
Year
Date
Name
First Name
Last Name
Child's Birthday
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Month
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Day
Year
Date
Name
First Name
Last Name
Child's Birthday
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Month
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Day
Year
Date
Name
First Name
Last Name
Child's Birthday
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Month
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Day
Year
Date
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Are you a recurring member?
*
Yes
No
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I understand that my participation and the participation of any members of my family in any Moms League of Aiken activity or program is completely voluntary and I hereby give permission for myself and my family to join in those activities and programs. My family shall hold harmless the Moms League of Aiken, any Moms League of Aiken volunteers, or material from any liability and/or responsibility for any accident, illness, or injury that occurs during or as a result of any function or program. I accept that the final responsibility for my safety and that of my family rests with me.
*
Yes
No
Signature
*
Member Name
*
First Name
Last Name
Date
*
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Month
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Day
Year
Date
I give permission to the Moms League of Aiken to share my FULL address and contact information on the Moms League of Aiken roster privately among the members in good standing. (This information will not be publicly shared. This is optional and will not affect your membership in any way.)
*
Yes
No
Signature
*
Date
*
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Month
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Day
Year
Date
I give permission to the Moms League of Aiken to use my or my child(ren)’s photogenic likeness in all forms and media for any lawful purposes. (This is optional and will not affect your membership in any way.)
*
Yes
No
Child(ren)'s Name(s)
*
Member Signature
*
I have received, read, understood, and agree to the Moms League of Aiken Host Responsibilities and Moms League of Aiken Code of Conduct.
*
Yes
No
Member Signature
*
Date
*
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Month
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Day
Year
Date
The yearly dues for membership in Moms League of Aiken is charged per family. It is due upon membership renewal each year. By signing I acknowledge this fee and agree to pay the following amount: $40
*
Yes
No
Signature
*
Date
*
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Month
-
Day
Year
Date
Renew Online
*
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Renewal
$
40.00
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