Marriage Encounter United Methodist
Reservation Form
 

Please provide the following  information:
* Required Information *

Weekend Choice
Weekend State	* Choose One AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY *
Weekend City	*       *
Weekend Month	* Choose One January February March April May June July August September October November December *
Weekend Date	*       *
Personal Information
Husband's First Name.........	* *
Husband's Last Name.........	* *
Wife's First Name..............	* *
Wife's Last Name..............	* *
Address.....................	* *
Address Line 2.........
City ............................	* *
State...........................	* *
Zip Code....................	* *
Telephone..................	* *
E-mail Address.........	* *
Church Information
Husband's Information:
Church Membership	Choose One United Methodist Other None
Name of church where you are currently a member
If other, church denomination
Are you Clergy?	No Yes
If yes do you need CEU credit?	No Yes
Wife's Information:
Church Membership	Choose One United Methodist Other None
Name of church where you are currently a member
If other, church denomination
Are you Clergy?	No Yes
If yes do you need CEU credit?	No Yes
Wedding Date
Referred By
Special Information
Special Dietary Needs
Type of Room	Choose One Non-Smoking Non-Smoking Handicapped Smoking Smoking Handicapped
Have you attended a Marriage Encounter weekend before?	Choose One Yes No
If Yes, When & Where?

Comments:

By typing agree in the space below and clicking submit you agree to
pay a $50.00 non refundable reservation fee for this Marriage Encounter weekend.
This form cannot be submitted without this agreement.
 

Type agree here *  * (all lower case)