Episcopal Marriage Encounter
Weekend Registration

Please print this form, fill it out completely, and snail-mail to:
Ron & Connie Bergeron
3350 Turtle Lake Club Drive
Marietta, GA 30067

Please make your registration fee ($45.00) payable to: "Episcopal Marriage Encounter" 

We wish to register for the ___________Weekend in_Atlanta
                               Date                                       

(Please Print names as you want them to appear on your name tags)


His first name:_________________


Her first name:_________________


Last name:______________________________________


Address:________________________________________

                       
City:______________________________
                          
State:_____
                       
Zip:__________-________                       

Phone:(     )______-___________
e-Mail ______________________________
                          
His Religious Denomination:________________________________                       


Her Religious Denomination:________________________________

                       
His church:____________________________________
                          

Her church:____________________________________

                         
Wedding date:_____/_____/_____






(Registration fee is not refundable and is transferable to any other Weekend.)




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