Clone of AFCM Gathering Special Request Form

Clone of AFCM Gathering Special Request Form

Couples Retreat Registration

Led By Rev.Dr. Kurien Puramadom
Name*

First NameLast Name
Email ID*
Phone Number*
Format: (000) 000-0000.
City Of Residence*
Dietary restrictions if any
Are you registering as a couple?*
Spouse Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email ID*
Dietary restrictions if any
Would you like to register for counseling ?
Retreat Schedule: Saturday 28th 10am to 6pm

Counseling: Sunday 29th 3pm to 6pm

Venue: 2205 Auraria Road, Dahlonega, GA 30533

Please zelle retreat fee $50 per participant to AFCM Atlanta using afcmatlanta@gmail.com to complete your registration.
Should be Empty: