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New Member

To have your name added to the newsletter mailing list or become new member, please fill out the Newsletter/New Member Form.

New Member Information

Information is strictly Confidential and will be used in the creation & mailing of newsletter and to inform members of Special Events, Meetings Etc…

Date
First Name
Last Name
Spouse
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Email Address
Relationship to Child
Child’s Full Name
Select Boy   Girl    Age
Date of Birth
Date of Death
Cause of Death
Surviving Siblings Names & Ages
Please add my name to the newsletter mailing list Yes   No   
Include my child in the “Our Children Remembered” section of the Newsletter Yes   No   
Include my child in the future “Our Children Remembered” section of the Website Yes   No   
How did you hear about us ?

Information contained in this form is confidential and will be used as indicated above for chapter newsletter and or website and in the chapter database contact information. I give The Compassionate Friends, Newburyport Chapter permission to use information as indicated. Permissions may withdrawn or added at any time by written request.

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