Application Process 1. Fill out the application form below. 2. Your application will be reviewed. Upon approval you will be sent a link to create your password and prompted to log-in and complete payment/registration. 3. Your membership will expire on July 31, 2019 unless you are a lifetime member (no expiry date). 4. If you have any questions/concerns regarding the application form or any general questions about membership, please contact membership@chdpom.com I would like to apply for:*Family Membership - $27 (families with twins who are under 6 years of age)Lifetime Membership - Free (families with twins who are 6 years of age or older)Note: for new members joining after Jan 1st 2019, you will pay a half-year membership rate of $13.50.Primary Member Name* First Last User Name*This is the user name you will use to log into the site when your membership application is approved. It cannot be changed later.Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Secondary Member Name (spouse / partner)Secondary Member Email Multiple’s NamesMultiple's Birthdate (or expecting date)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name(s) and Birthdate(s) of Other Children (if applicable)How did you hear about Chapel Hill-Durham Parents of Multiples?A current memberFriendDoctors officeInternet searchFacebookOur yard sale/consignment saleOtherHow did you hear about us?Additional Comments