Marriage Enrichment Interest Form

Marriage Enrichment Interest Form
Thank you for your interest in taking the first steps to enhance your marriage! If you have already attended a Becoming ONE Retreat or workshop, you are not eligible to attend.

To help us better meet your relationship needs, please complete this interest form. Only one (1) spouse needs to fill out the form.

We will reach out to let you know when we will have our next workshop or retreat. You will be emailed SURVEYS that you are required to complete to register. You must complete the ENTIRE REGISTRATION PROCESS TO ATTEND. If you have any questions about the Becoming ONE Program, please call Jim Harbin at 901.626.3603.
Have you already gone through the Becoming ONE Program?*

YesNo
Husband's Name*

First NameMiddle NameLast Name
Husband's Birth Date*

MonthDayYear
Wife's Name*

First NameMiddle NameLast Name
Wife's Birth Date*

MonthDayYear
Wedding Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Husband's E-mail*
example@example.com
Husband's Phone number*
Wife's E-mail*
example@example.com
Wife's Phone Number*
Referring Organization*
Are You a Pastor, Minister, Chaplain, or Serve in Ministry at a Church or Faith Based Organization?*
If Yes, Please Specify Your Role*
Husband's T-shirt Size
Wife's T-shirt Size
I understand that meals may be provided; however, we may not be able to accommodate individual dietary requirements.*

Yes, I understand
Couple's Favorite Love Song and Artist *
By checking each box below, I AGREE to COMPLETE all the surveys to enroll in the Becoming One Program PRIOR TO THE START OF WORKSHOP. (You and your spouse will receive three $25 gift cards for COMPLETING the surveys and completion of the program.)*
Please Share Any Additional Information Needed
Please Note: PHOTOGRAPHS AND VIDEOS ARE TAKEN AT ALL OUR EVENTS.
Should be Empty:

Marriage Enrichment Interest Form

Please Note: PHOTOGRAPHS AND VIDEOS ARE TAKEN AT ALL OUR EVENTS.