Marriage Encounter – Regis. Form

Registration - Marriage Encounter XXVI

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Strengthen and Revive Your Love Strengthen your marriage and continue cultivating your love every day. This encounter will be a special opportunity to reconnect, listen with your heart, and share quality time as a couple. Treat yourselves to a weekend just for the two of you. Your marriage deserves it!

Name (His)(Required)

First Name Surname

Name (Her)

First Name Surname

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email (His)(Required)

Email (Her)(Required)

Telephone Number (His)(Required)

Telephone Number (Her)(Required)

Married in the Catholic Church?(Required)

Yes

Married by Civil Law?(Required)

Yes

Do you have children?(Required)

Yes

Ages of Children?

Date of Anniversary(Required)

Emergency Contact Information

In case of a family emergency, closest adult child, family member, and/or friend we can contact:

Emergency Contact #1 Name:(Required)

First Surname

Telephone Number(Required)

Email(Required)

Emergency Contact #2 Name(Required)

First Surname

Telephone Number(Required)

Email(Required)

Additional Questions

Please provide any dietary restrictions, allergies, or physical limitations that we should be aware of:

The retreat will take place at St. Andrew Catholic Church, 9950 N.W. 29th St., Coral Springs. Transportation will be provided from the hotel to the church. The retreat will begin on Friday, September 25 at 6:30 PM in the St. Andrew Social Hall and ends on Sunday, September 27 at 6:00 PM. Cost and Payment Method: Total Cost: $300.00 per couple (includes meals, hotel, and transportation). Deposit required to reserve: $125.00 .Deadline for remaining balance payment: September 18. Cancellation Policy: The deadline to receive a refund is September 07 (the Encounter begins on September 25).

Payment Information

Non-Refundable Deposit(Required)

Deposit - $125.00

Full Payment - $300.00

Amount Due:

Billing E-mail Address:(Required)

Enter Email Confirm Email

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name