DMC Database Form Personal Data (* indicates a mandatory field) Date Applied * [MM-dd-yyyy] First Name * Last Name * Address * City * State Zip Code * Yahoo ID Email * Phone Number (9991234567) * Mobile number(9991234567) Child 1 first name * Child 1 Date of Birth or Estimated Due Date * [MM-dd-yyyy] Child 2 first name Child 2 Date of Birth [MM-dd-yyyy] Child 3 first name Child 3 Date of Birth [MM-dd-yyyy] Child 4 first name Child 4 Date of Birth [MM-dd-yyyy] Home-Based Business If you would like to have your home-based business listed in on our Member Business page, please complete the section below. Business Description Business Phone(9991234567) Business Email Business Website DMC Yahoo Discussion Group Please DO NOT add me to the DMC listserve (Yahoo Group) Printed Resources Please send me: * Preschool Directory/Mother's Morning Out List Durham Mothers Club Car Magnet Preschool Directory/MMO List AND Car Magnet None What challenges can we help you meet? (i.e., first baby, new sibling, special needs child, finding a preschool, Durham newcomer, etc) Challenges * Durham newcomer Finding a preschool First baby New sibling None Other Comments Comments Special Interest Groups Select those of interest Movie Night Book club Game Night Crafts Mom's Night Out First Time Mom at 35+ - MAMA (Moms of Advanced Maternal Age) Playgroup Playgroup Placement Name of Child(ren)for playgroup placement Special PlaygroupRequests (i.e.,day/time preference) Point of Interestnear your home * Duke Durham Regional Hwy 98 South Square Southpoint Max. time in minutesthat you'd drive for playgroup? (i.e., 15) Subdivision (i.e.,Hope Valley, Woodcroft) Waiver I agree to waive Durham Mothers Club, its officers, volunteers and members of all claim for personal injury or property damage that may arise from an event hosted by Durham Mothers Club. I have read, understood and agree to the terms and conditions stated in the waiver above * Membership Fees: Pay now using paypal OR mail your dues check (payable to "Durham Mothers Club") to Scottie Hunsberger, 5813 Rustic Wood Lane Durham NC 27713. Please indicate the payment method, reference and amount below: Payment method * Check Paypal Check # orPaypal ID * Annual Fee * $15.00 (paid by June 30th) $10.00 (paid after June 30th) Officer Member Type * New Member Renewal Officer - Current Officer - Past Officer Position (if you are current or past officerplease enter your position) For Internal Use Payment received Date Payment Rcvd [MM-dd-yyyy] Date Yahoo Group [MM-dd-yyyy] Verification Once you press "submit", a brief message will indicate that your membership form has been sent. In addition, you will also receive an email confirmation. Verification Code (enter the characters you see in the above picture) View Error Details Powered by
Home-Based Business If you would like to have your home-based business listed in on our Member Business page, please complete the section below.
DMC Yahoo Discussion Group
Printed Resources
What challenges can we help you meet? (i.e., first baby, new sibling, special needs child, finding a preschool, Durham newcomer, etc)
Waiver I agree to waive Durham Mothers Club, its officers, volunteers and members of all claim for personal injury or property damage that may arise from an event hosted by Durham Mothers Club.
Membership Fees: Pay now using paypal OR mail your dues check (payable to "Durham Mothers Club") to Scottie Hunsberger, 5813 Rustic Wood Lane Durham NC 27713. Please indicate the payment method, reference and amount below:
For Internal Use
