2020 -2021 Decide To Rise Form AHUMC MOPS

AHUMC MOPS 2020 - 2021 MEMBERSHIP FORM

I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. Psalm 139:14
Name

First Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
YOUR Birthdate (correct year not required)

Month Day Year
Have you attended a MOPS group before?

Yes No
If yes, where?
Have you already registered and paid for the MOPS International membership online at MOPS.org?

Yes No
Home Church (if applicable)
How did you hear about AHUMC MOPS?
Please list your child(ren)'s name(s) and birthdate(s):
Child 1 Name
Child 1 Birthdate

Month Day Year
Child 2 Name
Child 2 Birthdate

Month Day Year
Child 3 Name
Child 3 Birthdate

Month Day Year
Child 4 Name
Child 4 Birthdate

Month Day Year
Additional children's names and birthdates
I give AHUMC MOPS permission to use my photo for promotional uses

AHUMC distribution only Meetup Facebook ahumc-mops.org website AHUMC MOPS photo directory, AHUMC MOPS distribution only No photo permisions
I give AHUMC MOPS permission to use my child(ren)'s photo for promotional uses

AHUMC distribution only Meetup Facebook ahumc-mops.org website AHUMC MOPS photo directory, AHUMC MOPS distribution only No photo permissions

AHUMC 2019-2020 Membership dues

2020-2021 AHUMC MOPS Membership dues $ 80.00

I am unable to pay the $80 dues and would like to request a scholarship

I am requesting a scholarship. Please print this form and bring to the meeting.
Should be Empty:

AHUMC MOPS 2020 - 2021 MEMBERSHIP FORM