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2016-2017
MOPS Registration Form

Welcome! We are thrilled you have decided to join us!
Please complete this form to formally join Golden Triangle MOPS

and MOPS International.

First Name: Last Name:
Street Address:
City: Zip:
E-Mail:
Phone Number: Birthday:
Home Church (if applicable):

What is the best way to contact you? Check all that apply.

Call Text E-Mail Facebook Facebook Messenger

Do we have permission to photograph you, using those photographs for advertising purposes?

Yes No Initial X

Your Information

Your Children’s Information

Note: Only list children that will be attending Moppets.

Child’s First Name: Child’s Last Name:
Date of Birth (M/M/Y):

Child’s First Name: Child’s Last Name:
Date of Birth (M/M/Y):

Child’s First Name: Child’s Last Name:
Date of Birth (M/M/Y):

Child’s First Name: Child’s Last Name:
Date of Birth (M/M/Y):

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