Married Lovers Retreat Registration – Wait List

Step 1 of 3

PRIMARY CONTACT INFORMATION

Primary Contact Name *

First

Last

Primary Contact Email *

Primary Contact Cell Number *

COUPLE'S INFORMATION

Couples Last Name *

Husband's Name *

First

Last

Husband's Name Tag Preference *

First Name or Nickname

Husband's Cell Number *

Husband's Meal Preference *

Wife's Name *

First

Last

Wife's Name Tag Preference *

First Name or Nickname

Wife's Cell Number *

Wife's Meal Preference *

Wedding Anniversary *

Enter date using this format (MM/DD/YYYY)

Years Attending the Retreat *

ADDRESS INFORMATION

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact *

Emergency Contact*

Please check this box to complete your emergency contact information. Indicate any details required for contacting your emergency contact in the Emergency Contact Instructions section below.

PAYMENT

Payment Amount *

Full Payment of $575.00 USD is due upon registration and is non-refundable. Payment will only be accepted once the venue has space available. We will send a payment link the Primary Contact’s cell and/or email.

Name of Organization/Person Sponsoring Couple *

Please list the name of the church/organization providing the discount payment for attendance at the retreat.

Balance Due After Church/Organization Discount Applied *

Enter the dollar amount of the balance due after applying your church/organization discounts been applied.

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