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MotherToBaby Sign Up Information

Last Updated:

5/7/2020 1

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First Name, Last Name, Middle Name

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Home Address, City, State, Country, Postcode

Phone Number

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Membership Emails

Below is a sample of the emails you can expect to receive when signed up to MotherToBaby.

Organization of Teratology Inf...

Good Morning Mr. Lopez,

We have received your information through our website that you are interested in being a member of our organization however to make your membership an “Active” status, a $150 membership fee is required for membership. I am attaching a membership and credit card form if you prefer that method or you can mail a check to the address below or you can do it online through our website at www.mothertobaby.org.

We look forward to having you as a member. Please let me know if there is anything I can assist with at this time.

Sheena

Sheena de Giorgio, CMP| Grant and Membership Coordinator

5034A Thoroughbred Lane

Brentwood, TN 37027

OTIS/MotherToBaby

Direct: 615-423-2925

Office: 615-649-3082

Fax: 888-417-3311

Raw Data Registration Structure Registration Form Text

Registration

Membership Category Membership Type *

First name

Last name

Title

Password

Phone (mobile)

Home address

City

State

Country

Postcode

Middle name

Membership Category Membership Type *

Individual ($150)

Select the prefix

I am willing to share my contact information with other OTIS members

Select the prefix

Consent Information

I consent to the society sending me email correspondence relating to my membership, meeting attendance, meeting submissions or other society programs. *Please note if you do not tick the box offering consent, we will not be able to contact you with any future updates. Volunteer as Expert for Media Request(s)

Yes

Select the prefix

Susan Briggs Scholarship: The Susan Briggs Memorial Scholarship Fund is dedicated to the memory of Susan Briggs who passed away on June 28, 2009. Her husband, Jerry, has been Chair of the OTIS Research Committee for many years. According to Jerry, Susan always supported and encouraged his involvement in OTI

Data Name	Data Type	Options
Membership Category Membership Type *	Text Box
First name	Text Box
Last name	Text Box
Title	Text Box
Password	Text Box
Email	Text Box
Phone (mobile)	Text Box
Home address	Text Box
City	Text Box
State	Text Box
Country	Text Box
Postcode	Text Box
Middle name	Text Box
	option	Membership Category Membership Type *
	option	Individual ($150)
	file
	dropdown	Select the prefix
	dropdown	Select the prefix
	dropdown	Select the prefix
	dropdown	Select the prefix
	checklist
	checklist	I am willing to share my contact information with other OTIS members
	dropdown	Select the prefix
	dropdown	Select the prefix
	dropdown	Select the prefix
	checklist	Consent Information
	option	I consent to the society sending me email correspondence relating to my membership, meeting attendance, meeting submissions or other society programs. *Please note if you do not tick the box offering consent, we will not be able to contact you with any future updates. Volunteer as Expert for Media Request(s)
	option	Yes
	dropdown	Select the prefix
	number
	number
	checklist	Susan Briggs Scholarship: The Susan Briggs Memorial Scholarship Fund is dedicated to the memory of Susan Briggs who passed away on June 28, 2009. Her husband, Jerry, has been Chair of the OTIS Research Committee for many years. According to Jerry, Susan always supported and encouraged his involvement in OTI