Calvary Baptist Church
MomsNEXT 2011-2012 Registration Form
MomsNEXT Registration
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Name: *
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First Name
Last Name
Address: *
Address
Address Line 2
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City
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Email: *
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Email Address
Phone: *
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Phone Number
Birthday: *
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Have you been a member of MOPS or MomsNEXT before? *
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Select one
Yes
No
Are you a member of CBC? *
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Yes
No
Will you be bringing your school-aged children to MomsNEXT with you? *
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Select one
Yes
No
If no, please list the names and ages of your school-aged children. If yes, proceed to the next question.
required
MomsNEXT membership costs $23.95 this year. This includes membership to MOPS international and all of the benefits associated with it.
We do not want anyone to not be able to attend because of the cost. We will be offering reduced memberships or full scholarships to those who are in need.
Will you be able to pay the $23.95 MomsNEXT membership? *
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Select one
Yes
No
If no, please indicate which you are seeking:
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Select one
Full Scholarship
Reduced Membership
Please list the names, birthdates, and any allergies for all of your children that you will be bringing with you to MomsNEXT.
Name:
required
First Name
Last Name
Birthday:
required
Allergies:
required
Name:
required
First Name
Last Name
Birthday:
required
Allergies:
required
Name:
required
First Name
Last Name
Birthday:
required
Allergies:
required
Name:
required
First Name
Last Name
Birthday:
required
Allergies:
required
Name:
required
First Name
Last Name
Birthday:
required
Allergies:
required
Name:
required
First Name
Last Name
Birthday:
required
Allergies:
required
* required