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Southside Mothers of Multiples Club

2004-2005 Renewal Form

Please Print

 

Name:_________________________________________

 

Address:___________________________________________

 

Phone:____________________________________________

 

Spouse:___________________________________________

 

Email Address:_________________________ Loop: YES     NO

 

Children:

Name                                                           Birth date- (include year)

 

_________________________                 _____________________

 

_________________________                 _____________________

 

_________________________                 _____________________

 

_________________________                 _____________________

 

_________________________                 _____________________

 

I would like to volunteer my time in helping: (please circle)

 

Fall Festival     Christmas Party     Spring Fling    Mothers Day

 

In order to better serve our members, please include any suggestions.

 

 

 

 

 

Please remit this completed form along with your membership dues to:

$20.00 till July 14th - $25.00 till Sept. 9th (optional: $9.00 for National until 7/14)

Mia  Davis

Southside Mothers of Multiples

125 Grouse Point

Fayetteville, Georgia 30215