Registration Form
Please print this form with your web browser, complete the form, and mail to the address below.
Husband's Name _______________________
Wife's Name ___________________________
Address __________________________________
City _____________________
State __________ Zip ___________
Home phone _____________________
Daytime phone ______________________
(husband's or wife's?)
Number of years married _________
Number of children ___________
Religious affliliation __________________
Date of Encounter desired __________________
Alternate date ___________________
Names of friends who have made an Encounter:
_____________________________
_____________________________
Please mail this completed application plus a $50 non-refundable deposit to (this fee is transferable for 1 year):
The registration fee does not cover the entire cost of the weekend. You will be asked to make a free-will offering at the end of the weekend.
Celebrating, Serving, and Enriching Marriages
Since 1975