Personal Information
Type of Multiples (B – boy; G – Girl)
I would like to enroll in the following networks (check all that apply)
Are you interesting in volunteering sometime to POMBA? Do you have any special skills or resources that we can call on? Please let us know:
I consent for POMBA to provide my information to Multiple Births Canada to receive access to their private member’s benefits including: member’s only resources, national discount list and access to their social media site.
I/We acknowledge that I have read, understood and agree to the terms in the Photo Release Form.
If you do not agree to the terms above or have any questions, please contact us at