Agape Couples Ministry
“Keys To divorce-proofing your marriage” - Saturday May 28, 2016
REGISTRATION FORM
(Please Print)SECTION I
Person # 1
Last name:
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/ First name:
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☐ Mr. ☐ Mrs.
☐ Ms. ☐ Miss
☐ Other / Marital status (check one)
☐ Single ☐ Mar ☐ Div.☐ Sep. ☐ Wid. / Sex:
☒ M ☐ F / Wedding/Anniversary date: YYYY/MM/DD
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Address:
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City:
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Phone no.: / Email address:
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Person # 2
* ☐ Same address as above
Last name:
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☐ Mr. ☐ Mrs.
☐Ms. ☐ Miss
☐ Other / Marital status (check one)
☐ Single ☐ Mar ☐ Div.☐ Sep. ☐ Wid. / Sex:
☐ M ☐ F / Wedding/Anniversary date: YYYY/MM/DD
☐ (Same as above)
* Address:
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City:
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Phone no.:
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SECTION II
Registration Fee Information / Payment / OFFICE USE ONLY☐ $ 50 – Per Couple (Before May 1, 2016)
☐ $ 60 – Per Couple (After May 1, 2016)
☐ $ 30 – Single Registration / ☐ Cash
☐ Email Transfer *
* Email funds to
(Send password in a separate email) /
Dietary Needs:
☐ Vegetarian
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☐ KCLC
☐ Other (please explain): Click here to enter text.
☐ / We do respect your privacy. Please check box if you DO NOT want to receive emails for upcoming KCLC events. / Any future topics/events that would be of interest to you? (Please explain).
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More info: www.kclcministries.org Facebook Page: www.facebook.com/agapecoupleministries
Kingsway Community Life Centre Loving Couples Back to Life and Destiny