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Membership/Renewal Form
Lower North Shore Multiple Birth Association Membership/Renewal Form
This form is for both New Members and Existing Membership Renewal.
Please complete all sections of the online form. Fields market with a * are mandatory. Don't forget to make your payment.
   
(*)







Please specify your membership option
   
Please confirm we have the correct information about your family. If you're renewing your membership, you only have to provide the required information (*) and the details that have changed.
Parent 1 surname (*)
Please type your full name.
Parent 1 first name (*)
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Email address (*)
Invalid email address.
Parent 1 occupation
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Parent 2 surname
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Parent 2 first name
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Second Email
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Parent 2 occupation
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Address
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Suburb
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State
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Postcode
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Home Phone
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Parent 1 mobile phone
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Parent 2 mobile phone
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Multiple Type (*)
Please select
40 week due date is
Please select a date when we should contact you.
Are your twins, or some of your triplets/quads, identical?

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How did you hear about the Lower North Shore Multiple Birth Association? (Please tick)
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Other
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Do you speak a language other than English?
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If yes, please specify which language(s)
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Would you be willing to talk with another parent of multiples who speaks your language, should the need occur?
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Can we pass on your email address and phone number to the AMBA LOTE Officer?
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Are you interested in getting involved in the club, or assisting at fundraising events? Please specify any areas of interest.
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Would you like any specific information about the club or multiples?
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Are you interested in learning more about the Australian Twin Registry and the research they do? (*)
Please select
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Children (multiples & their siblings). If you're renewing your membership, you only have to provide the details that have changed.
Child 1 Surname
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Child 1 First Name
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Child 1 Date of Birth
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Child 2 Surname
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Child 2 First Name
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Child 2 Date of Birth
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Child 3 Surname
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Child 3 First Name
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Child 3 Date of Birth
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Child 4 Surname
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Child 4 First Name
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Child 4 Date of Birth
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Child 5 Surname
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Child 5 First Name
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Child 5 Date of Birth
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Communication and Privacy Preferences
I agree to receive emails from LNSMBA as part of my membership (*)
Please select
I agree to the publication of my families' names for acknowledgements, congratulations, children's birthdays etc in the newsletter (*)
Please select
I consent to the use of photos taken at club events on the club website, Facebook covers, and in promotional material, including but not limited to brochures and presentations (*)
Please select
I agree to LNSMBA forwarding my name and address to AMBA national for the purpose of mailing out the bi-annual AMBA Magazine (*)
Please select
My name and email address can be shared with other multiple parents in the LNSMBA (*)
Please Choose
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Name of person completing the application (*)
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Application Date (*)
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Type the characters you see in the picture (*) Type the characters you see in the picture
  Get other code
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