Central Bearden MOPS Registration 2013-2014
Please fill out this form to begin your registration.  Your registration will not be complete until Kelly Wells receives your dues for the year.  You can mail these to the church (attn: MOPS/Kelly Wells) or bring a check with you to any meeting or Mom's Night Out.
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What is your name? *
Please enter your first and last name
What is your Home phone number? *
What is your cell phone number? *
What is your address? *
Please list your complete address with street, city and zip code
What is your email address? *
What is your Birthdate? *
Please enter the month, day and year
Have you attended MOPS before?
If yes, please select 'other' and enter where you have attended MOPS in the past.
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Where do you attend church?
If you do not attend a church regularly please leave blank.
How did you hear about this MOPS group?
Please list your children's names and birthdates. *
Husband's name (if applicable)
During the meetings we break out into two different small groups.  Which small group would you like to be in? *
We will be making a member directory so our moms can keep in touch during the year and after.  Would you like your contact info to be shared? *
To complete your registration you must mail a check to Kelly Wells (or bring a check to any meeting) for the following amount: *
You have the option to have your dinners provided for you.  For a fee of $20 per semester MOPS will provide dinner at each meeting as well as a special dinner at the Christmas meeting.  Please make checks out to "Central Baptist Church of Bearden(CBCB)".
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