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Membership
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Circles
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1 YOU

2 YOUR MOTHERHOOD

3 YOUR CIRCLE

4 SUBMIT

Get in here, mama

Ready to meet your Circle? Fill out the form below (shouldn’t take more than 10 minutes) and we’ll get to work. You’ll tell us more about you and we’ll connect you with other moms going through it, too. Time to get real and get help. Our team will be cheering you on every step of the way.

Help us get to know you
FIRST NAME*
LAST NAME*
EMAIL ADDRESS*
We use your home address to gather a Circle as close as possible to where you live and mail you MotherNation swag. We respect your privacy and will never share your information. See our privacy policy for more info.
HOME ADDRESS*
HOME ADDRESS (OPTIONAL)
CITY*
STATE*
ZIP CODE*
GENDER
What gender do you identify as?
- Woman
- Gender Fluid
- Gender Nonconforming
- Man
- None of the above
RACE
What race(s) do you identify with?
- African
- American or Alaskan Native
- Asian
- Black or African American
- Latinx
- Middle Eastern
- Pacific Islander
- Southeast Asian
- White
- None of the above
How do you describe your gender?
How do you describe your race?

Get in here, mama

Tell us about your Motherhood

This helps us place you in a Circle that best fits your needs.
How many children do you have?*
Please include any babies you are currently expecting.
Birthdates or due dates:*
MM
DD
YYYY
Second birthdates or due dates:
MM
DD
YYYY
Third birthdates or due dates:
MM
DD
YYYY
Fourth birthdates or due dates:
MM
DD
YYYY
Fifth birthdates or due dates:
MM
DD
YYYY
Please select any shared experience that you would like to connect with other Mothers about.
We know this list is not exhaustive so feel free to add in your own. And the universal experience of Motherhood offers plenty of connection so totally fine to skip this question 😊
- Raising special needs children
- Mothers of color
- Raising NICU/premature babies
- Infertility
- LGBTQ+ families
- Self-employed Mothers
- Interfaith families
- Pregnancy loss/miscarriage
- Twins/multiples Mothers
- Single/newly separated Mothers
- Foster families
- Multi-racial/multi-cultural families
- Adoptive Mothers
- Working Mothers
- Surrogacy
- Families in recovery
- Blended families
- Stay-at-home Mothers
- Other

Get in here, mama

Your Circle
Do you prefer a virtual or in-person Circle?*
Due to the pandemic, all Circles are currently meeting virtually, but if you prefer in-person we'll keep it in mind for the future.
- Virtual
- In-person
- No preference
How important are the following statements to you?
I want to meet Mothers in my neighborhood.
I want to meet Mothers with kids the same age as mine.
I want to meet Mothers to connect over the shared experience selected above.
What is your main motivation for joining a Circle?
Select up to 2 options.
- Friendship
- Affirmation
- Community
- Empathy
- Solidarity
- Accountability
- Personal Growth
- Parenting Resources
Please select ALL times during which you are available to meet with your Circle.*
Circles will meet once a month for two hours. Please select at least 3 options.
- Weekday Morning
- Weekday Afternoon
- Weekday Evening
- Saturday Morning
- Saturday Afternoon
- Saturday Evening
- Sunday Morning
- Sunday Afternoon
- Sunday Evening
Any specific scheduling conflicts or preferences you'd like us to know?
Please list any pet allergies that may limit where you could meet.
Are you willing to host a Circle in your home?*
- Yes
- No
How many Mothers are you willing to host (including yourself)?*
Do you have any pets?*
- No Pets
- Dog
- Cat
- Other
How is the parking and transportation near your home?*
- Ample street parking
- Garage/paid parking
- Metro accessible
- Car share recommended
Anything else that we should keep in mind as we find your Circle?

Get in here, mama

Your Circle
Pick how you pay.*
- Monthly - $189/month for 3 months
- Upfront - $499
Promo Code
Credit Card*

Card Details

Cardholder Name
Billing Address*
Street Address Address Line 2 City State ZIP Code
Membership Terms*
I agree to the Member Agreement and the Declaration of Interdependence.

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How was it for you?

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