Please fill out the form below to register for a weekend or to request more information.

Marriage Encounter Weekend Registration Form

Name (His): (Hers): Last: Wedding Date (mm/dd/yy): Number of Children:

Address: City: � State:�� Zip:� Home Phone: Email :

Weekend Desired: option selected> February 18th - 20th, 2005 (Houston) October 21st - 23rd, 2005 (Houston) Alternate Weekend: option selected> February 18th - 20th, 2005 (Houston) October 21st - 23rd, 2005 (Houston) Room preference: Non-smoking Smoking

Please Send More Information: How did you find out about the Weekend? Include any additional questions, comments or special needs:

Religious Affiliation (His): Church (His):: Religious Affiliation (Hers): Church (Hers):

I am mailing my $45 check to: ILME Registration Red and Connie Warner 619 Whitehurst Court Katy, Texas 77450 (281)646-7274

When you click "Send", your information will be sent via e-mail to the Houston Area Registration Coordinators. You will be contacted by phone with further instructions. If you wish, print the form and send it along with your check.