Rogers MOPS Registration 2017-18
First Name *
Your answer
Last Name *
Your answer
Birthdate
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Have you attended a MOPS group before? If yes, where?
Your answer
Do you have a home church? *
If yes, where do you attend regularly?
Your answer
Our group communicates information via email and Facebook. Do you regularly use Facebook? *
Do you have a spouse that travels often?
If yes, would you like to be connected to other moms with traveling spouses?
What are the names/ages of your child(ren)? *
Your answer
Will you be bringing any children to the meeting? *
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