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South Eastern Multiple Birth Association (SEMBA)
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MEMBERSHIP FORM
SEMBA membership is $40.00 per annum (from 1 April to 31 March) or $75.00 for two years. If joining in January to March the following year's membership is included.
How to join
Step 1: Fill in your details on the form below.
Step 2: Pay your membership fees.
Please complete all of the details on the form below.
* denotes a mandatory field.
Membership details
*
A new member
Renewing membership
Transferring from another AMBA club
Member's given name
*
Member's surname
*
Partner's given name
*
Partner's surname
*
Postal Address
*
Suburb
*
Postcode
*
Contact phone number (home)
*
Mobile number
*
Email address
*
Expected due date of multiples (if unborn)
DD
/
MM
/
YYYY
Number of expected multiple birth children (if unborn)
1
2
3
4
More
Names of multiple birth children (if born)
Child 1
First name
Surname
Gender
Male
Female
Child 2
First name
Surname
Gender
Male
Female
Child 3
First name
Surname
Gender
Male
Female
Child 4
First name
Surname
Gender
Male
Female
Date of Birth
DD
/
MM
/
YYYY
Other children's names
Child 1
First name
Surname
Date of Birth
DD
/
MM
/
YYYY
Gender
Male
Female
Child 2
First name
Surname
Date of Birth
DD
/
MM
/
YYYY
Gender
Male
Female
Child 3
First name
Surname
Date of Birth
DD
/
MM
/
YYYY
Gender
Male
Female
Child 4
First name
Surname
Date of Birth
DD
/
MM
/
YYYY
Gender
Male
Female
Other Information
What member services are important to you?
Expectant parent sessions
Multiples information nights
Huggies nappies
Buddy program
Equipment hire
Playgroups
Family days
Social evenings
Involvement for dads
Activities for school-aged children
Other (please specify below)
How did you hear about SEMBA?
Friend/relative
Facebook
Maternal and child health nurse
Hospital
Other health professional
Other (please specify below)
SEMBA member
What is your occupation?
What is your partner's occupation?
Would you consider volunteering for SEMBA?
Payment options
Our preferred method of payment is direct transfer.
Account name: SEMBA
Bank: Bendigo Bank
BSB: 633 000
Account Number: 135760312.
Banking Reference: Your SURNAME.
You may also pay by cheque and send to:
SEMBA Treasurer
P.O. Box 5043
Bentleigh East
VIC 3165
Your membership will be confirmed once payment is received.
Thank you for becoming a member of SEMBA.
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