Register

To make things easier for you (since you may have one or four children hanging on your arm on the first day of Mops-September 19th) please feel free to print off a copy of the registration forms, fill them out at home, and bring them with you.

MOPS  REGISTRATION   2013-2014

Name: __________________________________________________________

Mailing address: __________________________________________________

City: _________________ Zip: __________ E-mail: _____________________

Phone: ________________ Birth date: ________ Husbands name: __________

Children Information:

1.  Name ___________________________       birth date: __________________

     Attending MOPPETS?    Yes / No                Allergies? __________________

2.  Name ___________________________       birth date: __________________

     Attending MOPPETS?    Yes / No                Allergies? __________________

3.  Name ___________________________       birth date: __________________

     Attending MOPPETS?    Yes / No                Allergies? __________________

4.  Name ___________________________       birth date: __________________

     Attending MOPPETS?    Yes / No                Allergies? __________________

Who would you like to sit with? _______________________________________

How did you find out about Life Center MOPS? __________________________

Church Affiliation, if any (optional)   ___________________________________

Payment option:

*Registration fee is prorated to first week attended. Registration fee will not be adjusted for weeks missed.

_____ First MOPS: $100 due 9/19/13 (can be made in up to 3 payments).

_____ Mentor Mom

_____ Leadership team

For Registration use only:

Registration Date:             Registration amount: $         Table:               Payment(s):

Entry work:

____ Database     ____ MOPS Membership     ____ Email List     ____ Follow-up/Welcome Email