MEMBERSHIP APPLICATION FORM

HARROW TWINS CLUB - 2011

Membership runs from January until December. Please complete the form and return it to Kathryn Stagg 66, Salisbury Rd, Harrow, HA1 1NZ along with your membership fee which is currently £10 or £6 if joining after August. (Cash or cheque payable to ‘Harrow Twins Club’)

Full Name: ______

Partners Full Name: ______

Address: ______

Post Code: ______

Telephone Number: ______

Email Address: ______

Preferred method of communication: e-mail / post (please delete as appropriate)

40 week Due Date: ______

(Expectant Mothers)

Details of all Children:

Name

/ Date of Birth / Sex / Birth Weight / Duration of Pregnancy (weeks) / Identical/Fraternal/Unsure

Please Turn Overleaf ÞÞÞÞ

Media

We sometimes receive requests from the media or film companies to interview or film multiples, especially identical twins. Would you be willing for us to contact you for any of the following?:

Please note that your name will not be disclosed until we have contacted you first.

Press articles Commercials Feature films

Serious documentaries Good causes NO

Baby/Toddler Group

Are you interested in attending the Baby/Toddler Group? YES NO

Evening Meetings for Mums & Dads

Are you interested in attending the Evening meetings? YES NO

Please give your ideas and suggestions for topics or issues that you would like to see covered at the Evening meetings: ______

______

______

______

Data Protection Act

In order to comply with the Data Protection Act your permission must be given to keep your details on our files. Therefore please complete the following:

I have no objection to my details being:

stored on computer or as a hard copy in the form of a contact list for committee purposes only.

circulated amongst the committee members only as a contact list.

WHAT MEMBERSHIP OFFERS YOU:

·  Access to books, leaflets and TAMBA magazines.

·  Access to videos on preparing for and coping with multiple births.

·  The opportunity to meet and talk to others who really do understand and can advise you based on their own experiences.

·  Regular meetings, usually with interesting speakers (an excuse for an evening out alone!).

·  Social gatherings with children and Dads too.

·  The occasional evening out for Mums only.

Thank you very much for taking the time to complete this form. Please remember to update us if any of your details change.

Please ensure all completed forms are returned to Kathryn with the membership subscription of £10.00 per annum by the end of February Ref: form2004