Mom-to-Mom Registration

"They devoted themselves to the apostles' teaching and to the fellowship..." - Acts 2:42

Mom to Mom Registration

*Last Name	Please enter your Last Name
*First Name	Please enter your First Name
*Address	Please enter your Address
*City	Please enter the City where you live
*ZIP	Please enter you Zip Code
*Phone	Please enter you Phone Number
*Birth Date	Please enter you Date of Birth
Your Church

Add to Brookfield Lutheran’s mailing list?

Yes

*Please indicate the session you wish to attend:

Wednesdays 9:15-11:15 a.m.

Wednesdays 6:30-8:30 p.m. (NO CHILDCARE)

How did you hear about Mom to Mom:

Is there one (1) person you would like to be in a small group with?

CHILDREN being registered for childcare at Mom to Mom (please include their last names if different from your own):

Wednesday Mornings Only

*Child's Name: *Birthdate:

If you are pregnant, when is your baby due?

*Required Information

Registration is complete when this form and your registration fee (payable to Brookfield Lutheran Church) are received.