NC Marriage Encounter On-line Registration Form

Marriage Encounter Logo

North Carolina
Worldwide Marriage Encounter
On-line Registration Form

If you wish to register for a Marriage Encounter Weekend, please fill out and submit this form.
Then write a $50 nonrefundable reservation check to
Worldwide Marriage Encounter and mail it to
Worldwide Marriage Encounter
18561 Sandpiper Place
Leesburg, VA 20176-3914

Husband's first and last names:
Wife's first and last names:
Street Address:
City:
State:
Zip Code:
(Area Code) Phone Number:
Your Email Address:
Your Wedding Date:
Which Weekend would you like to attend?
If you wish, select an alternate NC Weekend:
Number of children:
Husband's Religion and His Parish/Church:
Wife's Religion and Her Parish/Church:
Type of room desired:
Do you have any special mobility or dietary needs?

How did you hear about the Weekend?

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This page last updated May 20, 2010.