Reformed Engaged Encounter (Registration)

His Name	Age
Address
City
State	Zip Phone
His Church
Parent's Name
Parent's Address
Parent's City
Parent's State	Zip Parent's Phone

Her Name	Age
Address
City
State	Zip Phone
Her Church
Parent's Name
Parent's Address
Parent's City
Parent's State	Zip Parent's Phone

Wedding Date
Officiating Clergy
Clergy Home Church
Church Address
Choose a Weekend (1st Choice)	(2nd Choice)

E-mail address for confirmation

Please print this form and mail it, along with your $75.00 (U.S.) deposit, to:

Ross and Pam Landhuis
9766 Homerich SW
Byron Center, MI 49315

Make checks payable to Reformed Engaged Encounter

Registration must be made at least 2 weeks prior to your desired weekend.