Membership Application Form

Please use this form only to join Eastside Mothers Club. Current members who are renewing can simply submit payment – please don't use this form. Email questions and information requests to memb...@eastsidemothersclub.com.

Bold fields are required.

First Name:
Last Name: 
Address: 
City: 
ZIP: 
Phone #: 
Cell #: 
Email address: 
Spouse/significant
other's name: 		 
1st Child's:
Name:
Date of birth:
Gender: 		 
 
 
2nd Child's:
Name:
Date of birth:
Gender: 		 
 
 
3rd Child's:
Name:
Date of birth:
Gender: 		 
 
 
4th Child's:
Name:
Date of birth:
Gender: 		 
 
 
Where did you hear about EMC?
What did you do before mommyhood?
How many years have you lived in the Seattle area?
If you are a previous EMC member, when?

In which of the following are you interested?

Book Group Cooking Group Craft Group
Bunko Group Playgroups 

 

Eastside Mothers Club
PO Box 2611, Kirkland, WA 98083
memb...@eastsidemothersclub.com