Nottingham Trent Twins & Multiple Births Club

www.multiplebirth.org.uk
Membership Form

(all information supplied is confidential)

Title:- Mr, Mrs,Miss,Ms,Dr,Rev, other………………………(circle as appropriate)

Forename (s) ………………………………………………………………………… Surname …………………………….......

Address …………………………………………………………………………………………….………………………………………

………………………………………………….…………………. Postcode …………………………………………….................

Telephone …………….……………………………. Email ………………………………………………………………………...

Partner’s Name (include surname if different) ……………………………………………………………………..

Signature……………………………………………………………………………………….. Date………………………………

Children’s details

Expected date of delivery of twins/triplets ………………………………………………………………….......

Details of your multiple birth children:

Date of Birth: …………………………………….………(if delivered on different dates please advise)

First Born: Name: ………………………………………………………………………………………………………………....

Male/Female………………………………….. Birth Weight ………………………………

Second Born: Name: ………………………………………………………………………………………………………………..

Male/Female………………………………….. Birth Weight ………………………………

Third Born: Name: ………………………………………………………………………………………………………………...

Male/Female………………………………….. Birth Weight ……………………………….

Identical or non identical (if known)? Yes/No

Names and Dates of Birth of other children:-

 

Fees

Membership is £9.00 a year.

Please make cheques payable to NTT & MBC and send with this form to Sandra Pizzuti, Membership Secretary, 121 Muirfield Road, Arnold, Nottingham, NG5 9QR.

Please inform the Membership Secretary of any changes: telephone 0115 926 4191 or email us using
 the form on the 'contact us' page.

Questionnaire

Please take some time to answer questions about yourself and what you think of the Club. This will help us to help you, and to make sure that we do what our members want.

About You
How did you find out about the Club?

 

What do you hope to gain from being in the Club?

 

Daytime and Evening Meetings
Do you hope to attend daytime meetings? Yes/No
Do you hope to attend evening meetings? Yes/No
If not, why not?

Can you host an evening meeting? (£15.00 is given to cover cost of light refreshments for 10-20 people) Yes/No
What speakers or topics would you like covered at evening meetings?


Activities
Are there any activities which you would be particularly interested in attending (eg summer funday, barbeque, meal out, sponsored walks, swimming etc)?

Media
From time to time we are asked by the media for children to appear in adverts, articles, etc. Would you be interested in being contacted? (At NO time will details be given out without permission.) Yes/No Some members have asked if we could list members’ contact details and ages of children so they can contact others who are near them. May we publish your details in the newsletter regularly? Yes/No

Theatre Tickets
Sometimes the Club can arrange a group purchase of late availability theatre tickets at reduced cost. Would you like to be contacted about any tickets that become available? Yes/No

Disability
Do one or more of your children have a disability? Yes/No
If yes, would you be willing to share experiences with another member? Yes/No
Details of disability/ies:

Newsletter and Website
Do you have ideas for the newsletter or website (www.multiplebirth.co.uk)? Please give details:

Would you be interested in contributing ot the newsletter or website? If so, please give details:

May we use photos of your family on our website? Yes/No

Any other comments:

 

Please print this form and send it to the membership secretary - Sandra Pizzuti, 121 Muirfield Road, Arnold, Nottingham, NG5 9QR, along with the fee.
THANK YOU FOR COMPLETING THIS QUESTIONNAIRE