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Dutchess County POMs

Membership Form, 2009-10 /


Text Box:








Welcome to DC POMs! We hope you will find the support of the club helpful to you as you raise your family.

Would you please take a few minutes to complete this form so we can get to know you? Thank you for your time.


Please check box:



New Members: Your membership fee will be $20.  These dues include membership in the local, state, and national

Organizations for parents of multiples Dues also include a subscription to The Notebook, the National Organization of

Mothers of Twins Clubs’ magazine. This subscription will begin in January 2010, if you are joining prior to September 30th.

The $20 membership fee will be accepted until March 31st. First-time members joining April 1st thru July 1st will receive back

issues for the entire year and the fee will be $11.



Returning Members: Your $20 membership renewals are due no later than September 17th. Subscription to The Notebook

will begin in January 2010, if you are joining prior to September 30th.  Rejoining after the deadline will not receive back

issues and can expect their first Notebook to arrive in about four months.


Please send your dues, payable to DCPOMs, along with this form to:


2600 South Road, Ste. 44-160

Poughkeepsie, NY 12601


If you have questions, please leave a msg on our voice mail (845) 790-0327 or email the club at


Parent(s) Name(s)



Street Address



City, State, Zip






Email Address: please note: the vast majority of club notifications will be made via e-mail, including monthly meeting reminders and information



Parents’ birthdays




Please tell us about your children: 

child’s name

date of birth


child’s name

date of birth



























May we print this information on our member list (for members only)? (circle)    yes    no

Text Box:

Dutchess County POMs

Support Network Volunteer Form /









Please circle areas, if any, in which you would like to, get involved this year:


Refreshments at meetings



Newsletter Advertising

Special Needs





Educational Session Planning

Single Parenting

Big Sister

Daddy Playgroups


Meals for Members with Newborns




Installation Dinner Planning


Adults Night Out Planning

New Member Tea Planning

Family Picnic Planning


Holiday Dinner Planning


Kids’ Spring Party Planning

Kids’ Holiday Party Planning

Coffee & Conversation


Tag Sale Fundraiser



Stay-At-Home Dads

Dads or Moms Night Out




Meals on Heals



Website Promotion





Golf Outing

Book Club @ B & N

Misc. Outings: Dinner Shows, Plays, Concerts, etc.



How can DCPOMs best meet your family’s needs?  Please circle all that apply


Support / Advice



Items for resale


Evenings Out





Due to different schedules, how and when is the best time to reach you? {Please circle} Email  Home Cell  after:___________am/pm


Thank you for your time, if you have any questions, please feel free to visit our website at 



-File use only –


Received payment: Yes   No        Date: ______________     Cash / check #_________ 

Where did you meet new member: came to monthly meeting, playdate, club event, club party, other:_______________________

How did they hear @ us? __________________________________ 

Follow up:  ______________________________________

Forwarded to:  ____________________