Livermore Mom's Club - Join Online!

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Membership:
Join Online - Member Information

Completing the form below online is the fastest way to active LM benefits, but we also provide the paper forms in the box on the right. You can pay online using our PayPal portal and send us the paper form, or fill out the form online and mail your check. Whichever way makes you most comfortable is fine with us.

Want to use paper forms instead?

New Member Form (PDF)

Questions? Contact Membership

Step One:
Please complete the following information:
Your membership will not be active until both this member information and payment are received.

Member Information:
Member Status:	New Member Existing Member Renewal (if you have been a member in the last 12 months)
* First Name:		* Last Name:
* Phone Number:		Date of Birth: (optional)	Month & Day (year not needed)
Street Address:		* Email Address:	For monthly e-newsletter & club activity notification.
City, State & Zip:		Yahoo! ID:	Required to participate in Yahoo!Group discussions.
Your Occupation: (optional)			Your Yahoo! ID may or may not match your email address. What is a Yahoo! ID?
Family Information:
* Spouse/Partner Name: (optional)
* Child 1. First Name:		Child 1. Birth Year:
* Child 2. First Name:		Child 2. Birth Year:
* Child 3. First Name:		Child 3. Birth Year:
* Child 4. First Name:		Child 4. Birth Year:
* Child 5. First Name:		Child 5. Birth Year:

In the above information, an asterisk (*) indicates the information published in the membership directory. If any of the above information should not appear in the membership directory, please indicate in the box provided below:

Please explain where you learned of the Livermore Moms:

Livermore Moms Liability Release:

All members are required to agree to this liability release agreement before attending any activity programs.

I understand that my participation and the participation of any members of my family in any LM activity or program are voluntary, and hereby give permission for me and my family to join in those activities or programs. My family shall hold harmless the Livermore Moms, any LM volunteers or representatives, and/or the providers of any activity for any accident, illness or injury that occurs during any function or program. I accept that the final responsibility for my safety and that of my family rests with me.

I have read and agree to the Livermore Moms Liability Release.

Date of Agreement:

Your membership will not be active until both this member information and payment are received.