All information remains strictly confidential. Information, when submitted, is merged into a group summary report,
which cannot identify any spouse or couple.
Husband's First Name
Husband's Last Name
Wife's First Name
Wife's Last Name
Alternate Email address
Alternate phone contact
Do you require a handicap room?
Do you have any dietary restrictions?
If yes, please explain your dietary restrictions and needs:
Have you attended a Serving Marriages retreat before?
If you are serving or have served in the Armed Forces or as a first responder, please identify:
None of the Above
What Armed Forces Base or First Responder Department are you associated with?
(For Example: Moody Air Force Base, Georgia Air National Guard, Warner Robins Army (retired) ,Henry County Sheriff Department, Georgia, Hamilton County Fire Department, Tennessee, Jonesboro Police Department, Jonesboro, Georgia, or None of the Above)
How did you learn of our retreat?
Friend or Family Member
Previous Retreat Participant
What circumstances cause the most tension in your marriage?
How you spend your time
Rate Your Marriage 1
1 Seriously considering divorce and 10 being fantastic
"To the angel of the church in Philadelphia write: These are the words of him who is holy and true, who holds the key of David. What he opens no one can shut, and what he shuts no one can open." (Revelation 3: 7-10; NIV)
Copyright © 2011