Personal Information

Chaplain Wedding Training Registration
Personal Information
Name*

First NameMiddle NameLast Name
First Name*
Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Birth Date
E-mail*
Phone Number*

Area CodePhone Number
Practical Information
Reliable Vehicle*

YesNo
Driver's License*

YesNo
Cell Phone*

YesNo
I have read through the entire website and understand what is required of me*

YesNo
I have read the FAQ page*

YesNo
I agree to the Beliefs Statement*

YesNo
I agree to the Values Statement*

YesNo
I agree to the Marriage and Family Statement *

YesNo
I agree to the Personal Code of Conduct*

YesNo
I agree to a background check*

Yes
How did you hear about us?
Reference Information
Reference Name (person other than your spouse)*
Person other than your spouse
Reference Email*
example@example.com
Reference Phone Number*

Area CodePhone Number
Relationship to you (spouse not acceptable)*
Spouse not acceptable
Number of years known*
Please inform your reference that we will be sending them by email an electronic reference form that they will be required to complete.
Choose a Date*
LCI
Changed Format
Required date format

YearMonthDay
Required Date
Reminder Date

DayMonthYear
Reminder Date
Post Date

DayMonthYear
Post Training Date
Cancellation Email
example@example.com
Credit Card Payment Details

Information protected by GlobalSign*

Training$425.00

Practical Information