Member Registration Membership DetailsUser Name *For privacy reasons we recommend you do NOT use your email as your username.Password SpecificationsPasswords must be at least 10 characters long and contain upper and lower case letters, a number and a special character from this list: ,.?-!@#$%& PLEASE MAKE NOTE OF YOUR PASSWORD AS YOU WILL NEED IT LATER!Password *Email *Membership Level *free-testPrefixMissMs.Mrs.Dr.Mr.First Name *Last Name *Street *City *State *Zipcode *Country *Country: Select One Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Hong Kong Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Nepa Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands Yemen Zambia Zimbabwe Home/Cell PhoneWork PhoneGender * Female MaleYour Birth Date *Are you a woman who is *Please select an option*Attempting to become a single mother?Pregnant?A single mother by choice?Thinking about having a child?Interested in the subject of single mothers?A mother in another way?Other (please specify)Other:If you have children..Name of Child or ChildrenGender(s) of Child or ChildrenBirthdate(s) of Child or ChildrenAre you, or are you planning to, co-parent? * Yes No, not at this timeWhat is your marital status? * Never Married Divorced Widowed Other (please specify)Other Marital Status:May we include you in our Member’s Directory? Listing in the Directory will allow members near you to connect with you. Your listing will include your name, city, zip code, and email. NOTE: Our Directory is an online, password protected directory. Although we never share our mailing list with other organizations, if you are listed in the local members directory, we cannot of course, guarantee that other members will keep the information confidential.Member's Directory Opt-In: * Yes, please include me in the directory No, I do not want to be included in the directoryHow did you hear about SMC? If you were referred by a doctor, therapist, or another member, please provide their name so we can thank them. *Any additional comments:Privacy Policy *Please review our Privacy Policy I have read and agree to the SMC Privacy PolicyCommunications *SMC sends out periodic notifications to its members, including special offers, newsletter notifications, and updates about membership status. I agree to receive notificationsThank you! This box is for spam protection - please leave it blank: SHARE ON
