Worldwide Marriage Encounter - Allentown Diocese PA

Preliminary Registration Form

Husband's Full Name:

Husband's Nickname:

Wife's Full Name:

Wife's Nickname:

Address 1

Address 2

City

State

Zip Code

E-mail address

Phone Number

Work Phone Number

Wedding Date:

Husband's Religious Affiliation and Church

Wife's Religious Affiliation and Church

 

Select your preference

____ September 19 - 21, 2008 - Shillington, PA
____  November 14 - 16, 2008 - St. Francis Friary, Easton, PA
____  February 13 - 15, 2009 - St. Francis Center, Bethlehem, PA

Select and Alternate Date

____ September 19 - 21, 2008 - Shillington, PA
____  November 14 - 16, 2008 - St. Francis Friary, Easton, PA
____  February 13 - 15, 2009 - St. Francis Center, Bethlehem, PA

Do you have any special needs (diet, handicap, etc) so that we may accommodate you accordingly?

A $50 non-refundable deposit is required to confirm your registration.  Send your deposit (a check payable to "Worldwide Marriage Encounter") to :

Worldwide Marriage Encounter

P.O. Box 136

Emmaus, PA 18049

If you have any further questions or you would like to speak to our reservation couple personally please call

1-800-787-7679