Parent Talk - Join Membership Form

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Joining Parent Talk couldn't be easier. It takes only a few moments to complete our membership form online. And of course, if you have any questions, please don't hesitate to contact our Membership Chair, Kate Owens, at membership@parenttalk.info.

We are so glad you've decided to join Parent Talk!

Your membership will be active for one year from your membership date (date payment is received). After submitting this form, you will be able to pay online via Paypal. The membership fee is non-refundable. Confidential scholarships are available. Please contact president@parenttalk.info for more information.

I am renewing my membership.
Membership Level:
*First Name:
*Last Name:
Spouse First Name:
Spouse Last Name:
*Address:
*City:
*State:
*Zip:
*Phone:
*Email:

Please note that for security purposes a "1" is displayed instead of the day of the month your child was born.

Child 1 Name:	Birthdate:	(MM/1/YYYY)
Child 2 Name:	Birthdate:
Child 3 Name:	Birthdate:
Child 4 Name:	Birthdate:
Child 5 Name:	Birthdate:

Are any of the above children twins, triplets, etc?

Yes

How did you hear about Parent Talk?
Please provide additional details regarding how you heard about Parent Talk (e.g. friend's name or newspaper name).

Why did you decide to join Parent Talk?

I am interested in joining a playgroup.
Please provide any information that will assist us in placing you in a play group (i.e. which child/children, new moms, dads, nannies, Saturdays).

Would you like your name and contact information to be included in the Parent Talk directory?
Yes
No

Would you like to be included on email communications from Parent Talk?
Yes
No

ParentTalkOnline is the Parent Talk online discussion group, delivered by Yahoo! Groups, where members share resources and tips as well as discuss childcare, doctors, preschools, etc. If you would like to join the ParentTalkOnline discussion group, please complete the following section.

Preferred email address (for use with the Yahoo! group):
Re-enter preferred email address:
Optional secondary email address (e.g. for spouse):
Re-enter secondary email address (e.g. for spouse):

*Once your membership has been processed, which may take several days, you will receive an email from the Yahoo! Group inviting you to participate.

Please select any special skills you have.
To select multiple items, hold the Ctrl key down while making your selection.

Parent Talk offers members a number of social, support, and athletic groups. Please let us know if you are interested in joining or finding out more about the following:
To select multiple items, hold the Ctrl key down while making your selection.

Volunteering with Parent Talk is a great way to meet new people and give back to your community. In which area(s) below might you be interested in volunteering?
To select multiple items, hold the Ctrl key down while making your selection.

Know someone else who might be interested in Parent Talk?
Please provide their name and email address, and we would be happy to contact them:

You did it! Many thanks for your time and thoughts.

Please read the following paragraph and then click "Join Today"
to complete the membership process.

By submitting this form, I understand that I am fully responsible for my child(ren) while visiting the Parent Talk Playspace or participating in any event held at the Playspace, and that I am responsible for the care of my child(ren) during Parent Talk-sponsored playgroups and other activities. I also understand and agree that pictures taken during Parent Talk events may be used for Parent Talk publicity or advertising.