"*" indicates required fields 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 August 31, 2025 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 5. Chapel Hill-Durham Parents of Multiples is committed to the social and emotional support of parents of multiples. If you find yourself unable to pay the membership fee, please contact the membership team at membership@chdpom.com and they can provide information about our confidential scholarship program. I would like to apply for:* Family Membership, half-year - $18.00 (families with twins who are 5 years of age or younger) Lifetime Membership - Free (families with twins who are 6 years of age or older) 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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)*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name(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 saleOtherIf you chose "Other" above, how did you hear about us?Additional Comments