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Marriage Seminar Registration
First name
*
Last name
*
Email
*
Phone
Please select all that apply to your relationship, whether it was in the past or currently applies.
*
Communication issues
Escalated fighting (i.e. yelling, breaking items, threats to end the relationship)
Shoving, hitting, kicking, throwing objects at each other, belittling remarks
Infidelity
Addiction (e.g. gambling, alcohol, pornography, drugs)
Chronic illness
Mental diagnosis (e.g. depression, anxiety, ADHD)
Other
Are you and your partner committed to the growth of your relationship?
*
Yes
No
Other
Any dietary restrictions?
Seminar Fee
*
Pay in full
$
200
Reserve my spot (the rest is due at time of the event)
$
50
Register
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