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Friday, November 21, 2008

Wellington Multiple Birth Club Registration Form

Please complete the following form and submit to us to join. Please include your subscription fees of $35 per annum plus $10 joining fee.

These can be paid directly into our bank account Wellington Multiple Birth Club, Westpac Johnsonville Branch 031536 0001276 00. Please include your name as the reference. 

or by cheque posted to Wellington Multiple Birth Club, PO Box 1258, Wellington, Attn: Club President

 
Date*
First Name*
Surname*
Partners First Name
Partners Surname
Residential Address*
Postal Address
Home phone number*
Mobile Phone Number
Email Address
40 week Due Date of Babies*
Type of Twins
Details in newsletter
If paying by direct debit please include reference number here
Other Childrens details
Child 1 First and Last names
Child 1 Date of Birth
Child 2 First and Last Names
Child 2 Date of Birth
Child 3: First and Last Names
Child 3: Date of Birth
Child 4: First and Last Names
Child 4: Date of Birth
Free flow
Submit
*Required

Wellington Multiple Birth Club,

PO Box 1258

Wellington

Contacts:

New Members Contact

Jade Neill Tel 461 7008

President:

Fiona Purchas ph 938 3933


Vice President

Maree Bennett ph 970 9275

 
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