JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Marriage Adventure Registration
You are registering for the February 11-13, 2022 Marriage Adventure in Kansas City, MO.
Please answer all questions and submit. We will be in touch soon with more details.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name of Couple
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zipcode
*
Your answer
Phone Contact
*
Your answer
# Years Married
*
Your answer
Please share one thing you and your spouse hope to gain from attending The Marriage Adventure Workshop.
*
Your answer
How did you hear about our workshop?
Your answer
Are you in need of financial assistance? The $75 deposit towards your $295 registration will be due within 30 days of this registration. The remaining balance can be paid when you check-in on Friday of the workshop.
*
Yes
No
Maybe
We would like to arrive for check-in on Thursday prior to the event beginning on Friday. We understand that this is an additional fee of $110.00 plus tax payable directly to the hotel.
*
Yes
No
Maybe
Do you have any food allergies that we need to be aware of? IF you answer yes, please specify your need in the next question. Check ALL that apply.
*
Yes
No
Gluten
Dairy
Other:
Required
Workshop Registration Deposit* Mark all that apply.
*
PayPal payment [click on link]
https://paypal.me/tomjoblack?locale.x=en_US
We will mail a personal check to 33680 107th Lane, Nelson, MO 65347
We have a Gift Certificate to apply to our overall cost
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
