"Refreshing Your Marriage" Form for married and engaged couples.

Name

Spouses Name

This address will receive a confirmation email

Phone

Where do you attend church when you attend?

Will you need childcare? (Only for ages 1-5)

If childcare is needed, what is the age of your child/children? (Ages 1-5 only)

Dinner Choice (husband) salad and bread pudding included with both.

Pork loin, green beans and roasted potatoes Eggplant Lasagna

Dinner Choice (wife) salad and bread pudding included with both.

Pork loin, green beans and roasted potatoes Eggplant Lasagna

Payment per couple $60.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

2/26/26 6:30-9:00 PM

Please fill out this form and click submit.