MOPS Registration Page Mops Dues are $93 for the year, which can be paid at the first meeting. Please contact the coordinators for more information, or questions. MOPS Registration Form Welcome! Please complete this form so we can learn about you! Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone Number*Email* Birthday* MM DD YYYY Have you attended a MOPS group before?*YesNoIf yes, where?*Home church (if applicable)How did you hear about this MOPS group?Please list your child(ren)'s name(s) and birthdates(s):*Click the + button to add lines for more names.NameDate of Birth Husband's Name (if applicable)Mentor MomI would like to be assigned a Mentor MomYesNoRequest Mentor MomI would like to keep the same Mentor MomYesNoThe MOPS yearly fee is $93.*I will pay below with a credit card.I will by check or cash at the first meeting.Yearly Fee* Price: $93.00 Total which will be charged to your card: $0.00 Paying with a Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.