Call TOLL FREE:
877-907-2232
Email:
SOMAmothers@ureach.com
Complete the following form to sign up for membership online.
*
= Required Field
*
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Email Address:
*
Telephone:
(
)
*
Activities interested in:
*
*
Use the Control Key to select multiple items.
Playgroups
Nana's Playgroup at Winchester Gardens
New Mom's (with infants) Coffee
Stroller Rollers
HOOT OWLS (evening playgroup)
Mom's without Moms
Moms in the Workforce
Mom Owned Businesses
Seasoned Moms
Women Raising Men
Moms Night Out
Knitting Circle
Pop Fiction Book Club
Advocacy
CARE Network
Scrapbooking
Membership Committee
Mamas2one (raising an only child)
The Motherlode Newsletter
Committee/Activity Leadership
*
My Talents:
*
*
Use the Control Key to select multiple items.
Music
Publicity/PR Experience
Event Planning Experience
Graphic Design Experience
Fundraising (Ideas/Coordination)
Website Design
Other
*
Would you like to be added to the chapter's Yahoo! E-Loop?
Yes
No
*
Current Employment Status:
Select
Not Employed for Pay
Employed Part-Time
Employed Full-Time
Work From Home
*
Current or Previous Profession:
*
How did you hear about Mothers & More?:
Select
Friend
Flyer
Newspaper
*
Child (ren’s) Name(s) Birthdate (s):
*
Membership Fees: (In US Funds, Non-Refundable)
*
One Year Membership $45
*
Membership Type:
Select
Gift Membership
New Membership
Renewal
*
Method of Payment:
Select
Check
Credit Card
Checks should be mailed to:
Mothers & More.
Attn: Membership
P.O. Box 1112
Maplewood, NJ 07040
Please put SO/MA Chapter 128 in the Memo line.
*
If paying by Credit Card:
Select
Visa
Mastercard
*
Name on Card:
*
Credit Card Number:
*
Expiration Date:
00
01
02
03
04
05
06
07
08
09
10
11
12
-
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
*
3 Digit Security Code on back of card:
*
Comments:
Copyright 2007 South Orange\Maplewood Chapter of Mothers & More. All Rights Reserved.
