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2011-12 MGEFC MOPS Registration Form

Last Name: ___________________________________ First Name: ______________________________ M.I. ___


Home Phone: _______________________________ Alternate Phone: _____________________________________
Address: ______________________________________________________________________________________
City: ________________________________________________ State: _____ Zip code: _____________________
Email: __________________________________________________________ Birthdate: _____________________
Have you attended a MOPS group before? Yes No
If yes, where? __________________________________________________________________________________
Are you registered for the MOPS International Membership? Yes No
Home church (if applicable): _______________________________________________________________________
How did you hear about this MOPS group? ____________________________________________________________
Please list your child(ren)s name(s) who will be attending MOPPETS:
Name: ____________________________________________________ Date of Birth:
________________________
Name: ____________________________________________________ Date of Birth:
________________________
Name: ____________________________________________________ Date of Birth:
________________________
Other Children, not in MOPPETS(if applicable):_________________________________________________________
Husbands Name (if applicable): ____________________________________________________________________

MOPS International Membership Fee . $23.95


*If you already registered for MOPS this year, planning on attending at a different location and already paid the MOPS
Membership fee, you do not need to pay the membership fee again.

Group Semester Fee ... $40.00


MOPPETS Fee. $________
($10 per child, $25 family maximum)

Total .
$_________
Please make checks out to: MGEFC
Mail Form to: Paula Gilbert, 10710 39th Ave N., Plymouth, MN 55441
Questions? Email us at MapleGroveMOPS@gmail.com
For MOPS Group Use Only

Copyright 2011 MOPS International, Inc

Date registration received:


Discussion Group assigned:
Date registered for MOPS International Membership:

Copyright 2011 MOPS International, Inc