Couples Equality Interest Form

Couples Equality

Interest Form
Have you previously attended a "Couples Equality?"*

YesNo
If you answered "yes" to the above question When did you attend?
If you answered "yes" to the above question your registration will not be processed as you can only attend ONE Couples Equality.
Have both Husband and Wife previously attended an "Encounter" conference individually?*

YesNo
Husband's Name*

First NameLast Name
Wife's Name*

First NameLast Name
When did he attend his Encounter?*
When did she attend her Encounter?*
Contact Email*

Confirmation EmailPrimary email address (wife's or husband's) where we can send information concerning the conference.
Wife's Phone Number*

Area CodePhone Number
Husband's Phone Number*

Area CodePhone Number
City*
State*
Place of Worship*
Medical Food Allergies (Food Only)
Please verify that you are human*
Should be Empty: