2016-17 MOPS International Registration Form
**8/18/16 UPDATE: Our MOPPETS program is currently FULL. At this time moms are welcome to continue to join us, however they will need to find their own childcare. Babies under one years of age can stay with the mom during the meeting as a lap baby. If you wish to wait list your child(ren) for MOPPETS, please complete the MOPPETS Registration Form. **
Welcome! Please complete this form so we can learn about you!
Last Name:
Your answer
First Name:
Your answer
Home Phone Number:
Your answer
Alternate Phone Number:
Your answer
Address: (Street, City, Zip)
Your answer
Email:
Your answer
Birthday: (mm/dd)
Your answer
Have you attended a MOPS group before?
If yes, where?
Your answer
Please list one person you would like to sit with at your discussion table:
Your answer
Home church (if applicable):
Your answer
Are you interested in being a Discussion Group Leader?
Please list any skills or talents you would be interested in teaching at a Mom's Time Out:
Your answer
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