| mail to:
Mary E. Euler 286 Country Club Rd. Asheville, NC 28804 |
August - October $25
November - January $20 February - April $15 May - July $10 |
| Name ______________________
Join Date____________________ Mom's Birthday _______________ Husband's Name __________________ Phone# _________________________ Address _________________________ _________________________ _________________________ E-mail ___________________________ Multiples Names ___________________ ___________________ ___________________ Multiples Birthday ________________ Due Date __________________ Identical_______Fraternal ________ Siblings______________ Birthday________ _______________ ___________ _______________ ____________ Are you a stay at home mom? ____ If not, what is your occupation? _______________ Husband's occupation?_________________________ Please list any special certifications or training that could benefit our group _______________________________________________________ _______________________________________________________ Please list your hobbies & special interests________________________ ______________________________________________________ _______________________________________________________ Please provide any medical challenges or surgeries your multiples may have had or are now experiencing ___________________________________________________ ____________________________________________________ ___________________________________________________ |