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MOPS/MOPS TOO/MOPS XT Registration Form
Please note: There is a $24.00 registration fee due to MOPS International for every mom attending MOPS. This covers expenses incurred by MOPS International, and provides moms with the MOPS♥to♥MOM Connection which includes a one year subscription to MOMsense magazine, a free book, and other great offers. In addition, there is a $3 fee per meeting. This nominal fee covers costs such as crafts, decorations and dues. There is no cost for child care - our quality and loving child care is free!

* Required Fields
Main Information
* First Name
* Last Name
* Phone Number
* Email
* Address
* City
* State
* Zip

* Required Fields
* Group Preferred: (MOPS TOO - 1st & 3rd Thursday/MOPS - 2nd and 4th Thursday/MOPS XT 3rd Thursday Evening of every month)
1st & 3rd (MOPS TOO)
2nd & 4th (MOPS)
3rd Thursday (MOPS XT), 7-9PM

* Mother's Birthday:
* Child/Childrens name and birthdate attending MOPPETS
   i.e. Joan - 05/20/2004

* Child’s/Children's Allergies/Special instructions or enter none:
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