Page Title


	NORTHERN UTAH PARENTS OF MULTIPLES CLUB MEMBERSHIP FORM Date: ____________________________________ Name: ____________________________________ Your Birthday:______________________________ Address:___________________________________________________________________________ Phone: ___________________________________ Email:_____________________________________ Partner's Name/Birthday: ______________________________________________________________ Multiples (Name, Gender, Identical or Fraternal, Birthday): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Other Children (Name, Gender, Birthday): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ How did you hear about the club? ____________________________________________________________________________________ What would you like to get out of the club? ____________________________________________________________________________________ Additional Comments: ____________________________________________________________________________________ INSTRUCTIONS: The NUPM Membership Dues are $15.00. This includes membership in the National Organization for Mothers of Twins Clubs (NOMOTC) as well. Membership dues are up for renewal each July. Please submit payment made out to NUPM along with a completed copy of the Membership Form to: Northern Utah Parents of Multiples Attn: Membership 123 W. 1275 N. Layton, UT 84041 Thank you for joining NUPM! We are excited to be a part of your journey raising multiples!