Welcome to…

Next Session begins January 28th, 2010, 9am!

Please complete this form so we can learn some basic information about you.

Mom's Last Name:
First name:
Middle Initial:
Home Phone:
Alternate Phone:
City:
State:
Zip Code:
eMail:
Birthday:
Have you attended a MOPS group before?	Yes No
If yes, where?
How did you hear about this MOPS group?
Husband's name, if applicable:
Childcare: Please list your child(ren)'s name(s) and birthdate(s):

MOPS Registration Fee: $50.00

(All members receive "Life on Planet Mom: A Guide to Your Changing Relationships," six issues of the award-winning MomSense magazine, a weekly encouraging Mom-E-Mail, and the local group experience.)

Checks can be made out to "FOOTHILLS BAPTIST CHURCH."

Contact Jennifer Gressett for more information: jennifer@foothillsbaptist.org
or call the church phone: (480) 759-2118.