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

 

____October 15 - 17, 2010 - Fatima Renewal Center, Dalton (Scranton), PA

Select and Alternate Date

____October 15 - 17, 2010 - Fatima Renewal Center, Dalton (Scranton), PA

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

A $75 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

At the end of the weekend you will be given an opportunity to give a free will offering which will cover the expenses for the weekend.  These expenses vary depending on the location of the weekend.  Currently these expense are approximately $400.00.  Our registration couple can discuss this with you if you have any questions.

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

1-800-787-7679