Inspirit - For A Lifetime Registration Form printable pdf download

Inspirit - For A Lifetime

REGISTRATION FORM

(Please Print Clearly)

Name ____________________________________________________________________________________

Spouse-To-Be

____________________________________________________________________________ ________

Spouse-To-Be

Address ___________________________________________________________________________________

___________________________________________________________________________________

Contact Person ____________________________________________________________________________

Contact Phone # (______)___________________________________________________________________

Wedding Date _____________________________________________________________________________

Special Dietary Needs ______________________________________________________________________

We are registering for this program at the recommendation of:

Pastor ____________________________________________________________________________________

Church ___________________________________________________________________________________

REGISTRATION DEADLINE : 1 WEEK PRIOR TO THE EVENT

We are interested in registering for:

FORMAT I: One Day Retreat (Check One)

Cost Per Couple $150

___ Saturday, April 9, 2017

___ Saturday, October 7, 2017

St. Michael Lutheran Church

9534 Belair Road

Nottingham, MD 21236

___ Saturday, June 17, 2017

___ Saturday, January 20, 2018

Grace United Methodist Church

5407 North Charles Street

Baltimore, MD 21210

___ FORMAT II:

Cost Per Couple $240

One couple meets privately with a staff therapist for four 50 minute sessions

The content is the same as Format I.

Schedule the sessions through the Program Coordinator, John Michalczyk, 410-433-8861, ext. 160

Payment must accompany registration. Cancellation Fee: $25

Make checks payable to Inspirit and mail to:

Inspirit, For A Lifetime, 5407 N. Charles Street, Baltimore, MD 21210.

Confirmation of registration will be made by phone with receipt of registration.

Directions and last minute instructions will be made by phone 1 week before the event.

Any other questions or information please call 410-433-8861, extension 160

Inspirit - For A Lifetime Registration Form