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Worldwide Marriage Encounter - Northern Indiana Registration

To register for a weekend in Fort Wayne or South Bend, please electronically submit this form and send your $50.00 non-refundable registration fee made payable to Worldwide Marriage Encounter to:
POBox Worldwide Marriage Encounter
c/o Greg & Norma Germann
1304 Canterbury Drive
South Bend, IN 46628
(574)287-6432
Personal Information
Last Name Religious
Denomination		 Church
Name (Husband)
Name (Wife)
Street
City
State
Zip Code
Phone Cell Phone
Wedding Date
E-mail address    Verify E-mail address
Weekend Preferences
1st Choice
2nd Choice
Any Medical,
Physical,
or
Dietary
Restrictions