PART 1 - Membership Form



Membership Form

Fields marked with a * are required.

Parent name:*
Parent name:
Address Line 1:*
Address Line 2:
Suburb:
State:*
Postcode:*
Telephone: ()
Mobile:*
E-mail:*

Newsletters will be sent electronically unless specified below, in our bid to reduce our carbon footprint.

I do NOT wish to receive my MBA Newsletter electronically

Choose your Membership Level*

1 Year Family Membership including newsletter
(Half year discounted fee from 1 Sept)
$30
$15
2 Year Family Membership including newsletter
(18 month discounted fee from 1 Sept in first year)
$55
$40

Please either pay online via PayPal or make cheque/money order payable to Tasmanian Multiple Birth Association or Direct Deposit: BSB: 632-001 Account: 100110930.
Be sure to reference: Your full name on your payment.

  • Family membership entitles your family to attend functions free of charge unless specified otherwise, access to TasMBA resources, 4 issues per year of The Island's Multiple Collection newsletter, all issued editions of the AMBA Magazine that are produced during your membership year(s), and an AMBA Membership card with associated discounts at selected retailers.
  • Memberships are due on the 1st April of each year.
  •  
    Children's Names (First and Surname) singletons and multiples Date of Birth
    Due date of multiples:
    Twins Triplets Quads or higher
     
    Would you like to be contacted by our antenatal coordinator?*
    Yes
    No
     
    1. Do you give TasMBA permissions to use your name / photo and those of any others indicated on this form for internal publications? (i.e. for stories in newsletter)*
    Yes
    No
     
    2. Do you give permissions for TasMBA to use personal information for external publicity purposes (i.e. media stories)?*
    Yes
    No
     
    3. Do you give permission for your details to be passed on to the Australian Twin Registry (ATR) and to be contacted by the ATR for the purpose of explaining who the ATR are and what they do?*
    Yes
    No
     
    Additional Information (answering any of the following questions is optional):
    4. Do you have experience of any area that could be helpful to other parents
    (eg prematurity, colic, feeding issues etc)?:

    Do you want your details to be added to the AMBA Special Needs Register?
    Yes
    No
     
    5. Gestation period of your multiples? (in weeks):
     
    6. Are your multiples;
    monozygotic (identical)
    or dizygotic (fraternal)
    or both (for HOMs)
     
    7. Where did you hear about TasMBA (family, friends, Internet, doctor, hospital etc)?:
     
    8. Occupation of;

    Parent:

    Parent:

     
    9. What type of events would you find most useful to enhancing your multiple family experience (eg playgroup, parent and children morning tea, mum's night out, dad's night out, other social event, guest lectures – specify topic):
     
    10. Do you have any ideas or other comments that you would like to make:
     
    11. Member since (year):
     

    All original forms remain with the Tasmanian Multiple Birth Association Inc and they, along with statistics gathered, are stored confidentially. Access to the data collected from the membership form is only available to committee members of TasMBA.

    When complete, please submit form and either pay online or send payment to:

    Treasurer
    Tasmanian Multiple Birth Association
    PO Box 238
    Rosny Park Tas 7018
     



    Membership Form
    Version 6-1








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