Couples Equality
Interest Form
Have you attended a Couples Equality previously?
*
Yes
No
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.
Both Husband and Wife have previously attended an Encounter conference individually?
*
Yes
No
Husband's Name
*
First Name
Last Name
Wife's Name
*
First Name
Last Name
When did he attend his Encounter?
*
When did she attend her Encounter?
*
Contact Email
*
Confirmation Email
Primary email address (wife's or husband's) where we can send information concerning the conference.
Wife's Phone Number
*
-
Area Code
Phone Number
Husband's Phone Number
*
-
Area Code
Phone Number
City
*
State
*
Place of Worship
*
Medical Food Allergies (Food Only)
Please verify that you are human
*
Submit
Should be Empty: