Christchurch Multiple Birth Club

Registration/Update Info

NOTE: if you are already registered please enter your User Name and Password in the Login/Register box OR if you have forgotten your log in details click on 'Forgotten Password' in the login box.

UPDATING: if you are updating your contact details, please send a quick email to our Membership Secretary to make her aware of the change.

Please complete this form with as many details as possible.

You will receive an email containing payment details - please action this if applicable
Please allow 1 month processing from the receipt of your payment
Once your application has been processed, you will receive your CMBC Membership Card
Advertisers - you will be contacted by our advertising co-ordinator
If you have any questions prior to registering, please contact our Membership Secretary.

Thank you for your interest in the Christchurch Multiple Birth Club!

Enter the details below to register on this site.
NOTE: The fields with an asterix (*) must be filled in.

Name Details

First Name*:
Last Name*:

Postal Address/Contact Details

Street:
Suburb:
City:
State/Region:
Postal/Zip Code:
Country:
Email*:
Phone No: Please include area code*
Fax No: Please include area code
Mobile No:

Personal Details

Gender:	Male Female
Date of Birth:	(e.g.1999)

Survey Questions

Spouse/Partner Details (list full name & contact details if different):

Multiples Date of Birth/Expectant Date:

Full Name (child 1):
Child 1 Gender:	Female Male
Full Name (child 2):
Child 2 Gender:	Female Male
Full Name (child 3):
Child 3 Gender:	Male Female
Full Name (sibling 1):
Sibling 1 DOB:
Full Name (sibling 2):
Sibling 2 DOB:
Full Name (sibling 3):
Sibling 3 DOB:
Would you like a buddy?New & Expectant parents only:	Yes No
What Membership level would you like? (tick as many as apply):
Full Financial Member: $25/yr Associate Member: $15/yr Other
If 'Other', please specify if you are a supporter/discounter/advertiser:

How will you be paying (tick as many as apply):
Cheque Internet Payment
I give permission for the CMBC to use my personal details for: the membership database; emailed event updates; magazine information (such as welcome to new members and babies, expectant parents and birthday list) and photographs taken at events for publication in the magazine & members only areas of the website. Note your information will otherwise be kept in confidence in accordance with the Privacy Act 1993. :*
Yes No