HONG KONG MOTHERS of MULTIPLES ORGANIZATION

Application for Membership 2008 - 2009

 

 

ž      First Time Member                             ž      Renewal 

 

Family Name: 

 

Mother: 

Father: 

Address:

Home Phone:

 

Home Fax: 

 

Work Phone:

 

Mobile: 

 

E-mail: 

                                                                                               

Names of Multiples

Date of Birth (dd/mm/yy)

Sex

Fraternal or Identical

 

 

 

 

 

 

 

 

 

 

 

 

Other Children

Date of Birth (dd/mm/yy)

Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have any suggestions for events?

 

 

 

 

 

Can you provide a venue (home/club/other) for future get-togethers?

 

Venue:

Home for a small group: Yes/No

 

 

Do you know of someone who could be a speaker at one of our lunches?   

 

If yes, name and contact number:

Topic of discussion:

 

 

Please complete the above form and return it with your crossed cheque for the annual fee of $350      

 (1st September – 31st August) or semi-annual fee (i.e. March - August) of $175, made payable to

“Hong Kong Mothers of Multiples Organization” to:    

 

Selina Kuok Picazo

Apt. 2283, Tower 15, HK Parkview,

88 Tai Tam Reservior Road,

Hong Kong

 

FOR OFFICE USE ONLY

Name:  ………………………………………………………………..                      Membership No:  …………………………

 

Cheque No:  …………………....  Bank:  ………………………….                  For:    HK$ ………………………….………

(Annual Fee $350  1st September- 31st August  OR  $175   March - August)