Payment Options
To Pay By Check: Do not fill out the form below. Instead, print out this form and send it to:
Northside Twins and Multiples c/o Amanda Barnum 12409 River Valley Drive Fishers, IN, 46037
To Pay By PayPal: Please complete the online form and submit. Once your information has been received you will be contacted with a paypal invoice and instructions on how to proceed. Please note that website access will not be granted until payment has been confirmed. You will be contacted by the website administrator once your access has been approved with further instructions on using the website.
Account information
Section 1 - Personal Information
Birth Month: *
January February March April May June July August September October November December
Birth Date: *
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Last Name: *
First Name: *
Street Address: *
City: *
State: *
ZIP Code: *
Home Phone: *
Work Phone:
Cell Phone:
Occupation: *
Preferred Email: *
Personal Website:
Fax:
Significant Other's Last Name:
Significant Other's First Name:
Significant Other's Occupation:
Section 3 - Name of Child (1)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (2)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (3)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (4)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (5)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (6)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (7)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 3 - Name of Child (8)
Name:
Gender:
-- Female Male
Zygosity, if applicable:
-- Identical Fraternal Unknown
Section 4 - How Did You Hear About Northside Twins and Multiples?
I heard about Northside Twins and Multiples from:
-- Doctor (please enter name below) Member (please enter name below) Friend/Relative Someone I do not know Web/Website NOMOTC IFMOTC Clothing Sale Flier Ad in local media Other (please enter source below)
Other:
Section 5 - What services of Northside Twins and Multiples are you interested in? (Check all that apply)
Programs/Speakers
Resource List/Books
Couples/Adult Nights
Friendship
Education
Playgroups
Mom's Night Out
Community Service
Website Support Forum
Big Kid Club (age 3+)
Section 6 - Are you interested in joining any of the following committees? (Check all that apply)
Pre-membership
Fundraising
Playgroups
Clothing Sale
Website
Big Kid Club (age 3+)
Parliamentary Process
Cheer
Public Relations
Newsletter
Adult Social
Refreshments
Programs
Children's Social
Service
Section 7 - Membership Class: Active Member (membership 1-3 years)
Section 7 - Membership Class: Alumni Member (membership 4-10 years)
Section 7 - Membership Class: Lifetime Member (membership 11+ years)
Section 8 - Additional Information (Check all that apply)
Section 9 - Additional Comments