General Directions:

This form is to be filled out by a parent of multiples and will be used to enter information about you and your multiples into a CONFIDENTIAL, computerized data base maintained by the National Organization of Mothers of Twins Clubs, Inc.

Many of you may have previously completed a Multiple Birth Data Form. However, this is a new updated version. Please complete this form even if you provided information on a former form. Complete this form only once. If you have more than one set of multiples, please fill out a separate form for each set.

Please be aware that the information you provide on this form will only be used as part of collective data, with no reference made to specific individuals. Approved researchers and/or casting directors sometimes request personal information on specific groups of individuals. However, personal information (name, address, e-mail, etc.) will be released only with your permission. Your signature on page 3 of this form represents that consent.

After completing your initial form, should you need to change or update any of the information provided, please fill out another form: mark the form as an UPDATE submission, complete the section on personal information, then mark only those areas applicable to change.

You are free to have your information deleted from the data base at any time through a written request to Multiples of America.

Read each question carefully and place the appropriate number (or answer) in the blank. Please write neatly.

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