| Husband | |
|---|---|
| Mr/Dr/Rev | |
| Surname | |
| First or preferred name | |
| Wife | |
| Mrs/Dr/Rev | |
| Surname | |
| First or preferred name | |
| Address | |
| Telephone | |
| Date of Marriage | |
| How did you hear about Marriage Encounter? | |
| Husband | _______________________________________________ |
|---|---|
| Wife | _______________________________________________ |
| Loretta and Mark de Sousa 177 Janice St. North Bay, ON P1B 6M1 (705) 497-5823 [email protected] |