MOMCo REGISTRATION FORM

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We are excited to have you join us this coming year! Please fill out the form below. Registration includes international membership, MomCo magazine subscription, local dues for supplies, child care during meetings, and a T-Shirt. All Morning Group registrations paid before June 1st are $60 if paid after $75. Evening group registration is $50. All Mentor Mom registrations are FREE! Payment plans and scholarships available.

Your Name *

Do You Wish to Attend a Morning Meeting or Evening Meeting For the Year? *

Morning

Evening

Mentor Mom Morning

Mentor Mom Evening

Other:

Your Email *

Best Contact Number *

Your T Shirt Size *

XXL

Your Wedding Anniversary *

Your Birthday *

YYYY

Your Mailing Address(Please include your zip code) *

Please list your children's names (Mentor Mom's can answer NA for this question) *

Please list your children's birth dates for the international account *

How do you plan to pay for your registration? *

In full now - You will be emailed an invoice through square in the next 48 hours

Half now and Half in August - You will be emailed an invoice through square in the next 48 hours

I would like to be considered for a scholarship

If you are in need of a scholarship please chose below which scholarship you would like to be considered for.

I am able to pay the International fee of $37 but need assistance with the local fee of $38 ($23 Early Bird)

I am able to pay the Local of $38 ($23 Early Bird) but need assistance with the international fee of $37

I can pay another amount but would like assistance with the remainder

I am not able to pay any of the fees and am in need of a full scholarship

I am registering for the Free Mentor Mom Registration and do not need to pay or scholarship

Clear selection

If you are in need of a full scholarship please explain your situation below.

All information about this application is kept in the strictest confidence with the Finance Director. Please denote below that you agree to the following: I have thought about and prayerfully considered my financial situation and spending habits. If my financial situation changes I will inform the MomCo coordinator immediately so the money can be made available to meet other women's financial need. I commit to being a faithful attender of MomCo at Kennesaw First.

Yes

Clear selection

Submit

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