Membership
Form for NEW and RENEWING
Member of Central Denver Chapter #218
This information is confidential and is for Mothers
& More use only. Please print this form and mail it in with your check to the address listed at the bottom.
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New Membership: ______ Renewal Membership: ______ Chapter Change: ______
NAME: _____________________________________________________
ADDRESS: __________________________________________________
CITY : STATE: ZIP: _____________________________________________
PHONE: ___________________________________________________
EMAIL: _______________________________________________
Current employment
status:
___ Not employed for
pay
___ Employed
part-time
___ Employed
full-time
Current and/or former occupation: ________________________________________
Child(ren)’s name(s)
and birth date(s):
____________________
___/___/___ ____________________
___/___/___
____________________ ___/___/___ ____________________ ___/___/___
____________________ ___/___/___ ____________________ ___/___/___
Please return these forms and a check to:
Mothers and More Membership, PO Box 100783 Denver, CO
80250
Also please email our Local Membership Coordinator
mothersandmoredenver@yahoo.com
Make your check payable to: MOTHERS & MORE. Annual dues: $45.00
If
you would like to receive a one year subscription to the Brain Child Magazine
please make check for $55, an additional $10.
www.brainchildmag.com
NATIONAL COPY
Local NEW member information sheet for
CENTRAL DENVER CHAPTER #218
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NAME: _______________________________________ SPOUSE’S NAME: ______________
YOUR B-Day (Mo/Day): _____________
Brief description about
yourself -- interests, hobbies, skills
______________________________________________________________________________________
______________________________________________________________________________________
Do you have any particular
areas of knowledge; talent or skill that you feel might benefit the group?
_____________________________________________________________________________________
______________________________________________________________________________________
What areas are you interested
in? Please indicate your interest level using this code:
1 - High Interest 2 - Moderate Interest 3 - Low or No Interest
Moms-Only Meetings_____ Margarita Night _____
Craft Day_____ Mom’s Night Out _____
Book Club_____ Playgroups (Infant) _____
Fieldtrips_____ Playgroup (Toddler) _____
Gourmet Club _____ Seasoned
mom (kids 4 and up) _____
Guest Speaker _____ Special
Events/Parties_____
Leadership_____
Other _________________________________________
Would you be willing to host or volunteer in any of these areas?
Playgroups _____ Events for Moms _____
Web-Page Design _____ Marketing/Publicity _____
Guest Speaker _____ Care Committee* _____
Any Open Coordinator Position_______
Other ___________________________________
* Care Committee is a group of members who prepare meals for new mothers. We also help members after surgery, during illness or before a move.
What are you hoping to find at Mothers & More? (Friendship, socialization, networking, adult interaction with women of common interest, information, etc.) ________________________________________________________________________
How did you find
Mothers & More?
________________________________________________________________________
Comments, suggestions or expectations: ________________________________________________________________________
________________________________________________________________________
LOCAL COPY