Groom's Information

First Name:    Last Name:

Street Address:    City:    State:   Zip:

Cell Phone:  Home Phone:  

Age:    Religion:  

Current Parish:   City:

Your EMail:   Very Important : Please double check your email address for accuracy.

  Special Needs vegetarian handicap accessibility

Bride's Information

First Name:   Last Name:

Street Address:   City:   State:   Zip:

Cell Phone: Home Phone:  

Age:   Religion:

Current Parish:   City:

Your EMail:   Very Important : Please double check your email address for accuracy.

  Special Needs vegetarian handicap accessibility

Additional Information

Wedding Date: (Please use the format MM-DD-YY)    

Parish to be Married In:   City:  

Name of Priest:

Referred By:

Engaged Encounter Weekend Preference:

First Choice -Select- July 16–18 2010 August 13–15 2010 September 17-19 2010 November 12–14 2010    Second Choice  -Select- July 16–18 2010 August 13–15 2010 September 17-19 2010 November 12–14 2010

Direct All Correspondence to:  -Select- Groom's Address Bride's Address

Contact Info After Your Wedding:

Street Address:   City:   State:   Zip:

Phone:  

EMail: Very Important : Please double check your email address for accuracy.

Your Parish After the Wedding:

Parish:   City:

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