Attended MOPS before:  Yes or  No   If yes, where? 

Children:

Name:   Age: 

Name:   Age: 

Name:   Age: 

Name:   Age: 

Will you bring your kids with you to MOPS meetings?  Yes   No   Sometimes 

If so, which kids? 

Do they already attend on Wednesday nights?  Yes    No    Sometimes 

MOPS dues:

MOPS International: $25, Semester One: $30, Semester Two: $30    

Total MOPS Registration per Person: $85  [Pay by cash, check or online!]        

            Make check payable to First Assembly Community Ministries (memo: MOPS)