Mennonite & Brethren Marriage Encounter

There is a non-refundable fee of $100 due when you submit your application.
(Marriage Encounter is recommended for couples who have been married for at least two years)

Weekend Registration:
Husband’s First Name: Wife’s First Name:
Last Name:
Street Address:
Address Line 2:
City: Province or State:
Postal Code or Zip: Telephone #:
E-Mail address:
Wedding Date:
Church and/or religious affiliation:
Dietary Restrictions:
Are you a credentialed pastor couple? YesNo
We ask that you invite a couple to be your prayer partner during your weekend. Please provide that couples’
name and contact information.
Telephone #: Email:
How did you hear about Marriage Encounter?
Please answer a simple Math Question:

809 Temperance Hill Road
Lititz, PA 17543 U.S.A.
(717) 569-5676

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