Pre-Marital/Marriage Coaching Form
Please complete this form so that we can get a better understanding of your needs. Coaching sessions are available on Tuesday, Wednesday or Thursday evenings. Coaching sessions each last 1 hour. For the SYMBIS Coaching Package, a $150 non-refundable deposit is due in order to secure a start date for coaching, and the remaining balance is due 7 days prior to your first session. Full payment is required to secure a single session.
How did you hear about Millennium Marriage?
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Referred by a friend
Social Media
Search Engine (Google, Yahoo, Yelp, etc.)
Community Event (Wedding expo, conference, etc.)
Publication (Venue brochure, magazine, news article, etc.)
Other
Couple Information
Bride's Name
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First Name
Last Name
Groom's Name
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First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Date of Birth
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Month
-
Day
Year
Date
Email
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example@example.com
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload 1 photo of you together as a couple for our files.
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Relationship Status
What is your current relationship status?
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Engaged
Married
Separated
Wedding or Anniversary Date
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Month
-
Day
Year
Date
What type of coaching are you interested in?
SYMBIS Premarital Coaching: For engaged couples, includes SYMBIS Assessment, four 1 hour sessions, SYMBIS book & workbooks, & certificate of completion. $700 package
SYMBIS Marriage Coaching: For married couples, includes SYMBIS Assessment, four 1 hour sessions, SYMBIS book & workbooks, & certificate of completion. $700 package
Marriage Maintenance Session: For married couples, includes one, 1-hour coaching session to identify challenges or areas of improvement and providing practical tools to address them. Sessions can be scheduled on an as needed basis. $150 per session
Describe why you are interested in pre-marital or marriage coaching. (ie: establishing a foundation before marriage; currently experiencing challenges in our marriage; etc.). Please tell us about any specific topics or challenges that you would like specific support for.
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Promo Code (if applicable)
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