Weekend Registration:

[lista_weekends type="ME"]

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.

Name:

Address:

Telephone #:

Email:

How did you hear about Marriage Encounter?

Please answer a simple Math Question:

2*2=