Membership Information Form

Name:__________________________ Date:_______

Address:________________________

_____________________________________________                                             

Phone:__________________________

Spouse's Name:___________________

Email:__________________________

Children's Names:                      Dates of Birth:

______________________________________    __________________________________

______________________________________    __________________________________

______________________________________    __________________________________

______________________________________    __________________________________

Circle Areas of Interest:

Playgroups   New Moms' Support Group   Babysitting Co-op  
Helping Hands    Toy Co-op   Working Moms

To join the Club, send a $20 check made payable to
Greater Nashua Mothers' Club and mail to:

                       Membership Coordinator
               The Greater Nashua Mothers' Club
                                P.O. Box 124
                      Nashua, NH  03061-0124

Membership dues for 1999: $20     (joining sept-nov $15 /  dec-jan $10)