Atlanta Area Marriage Encounter

Dedicated to the strengthening of Marriages and the rekindling of romance


World Marriage Day Valentine Ball Reservation Form
February 13th, 2010
Fields in RED are required. When you are done click "Calculate" and then "Proceed to Info Verification..." at the bottom of the form.
Use <Tab> to go between fields. Do NOT use <Enter> or it will assume you are done.
Space is limited, so please get your reservation in as soon as possible.
Your reservation is not complete until payment is received by the WMD Valentine Ball Committee.
For questions about registrations, contact Ed  Nancy Poorbaugh @ 678-682-9246 or
email @ worldmarriagedayball@gmail.com
Last name:
Husband's name:
Wife's name:
Telephone number:
( ) 
Email address:
Mailing Address:
Parish or Church:
How did you hear about the World Marriage Day Valentine Ball?
Would you be interested in information about Marriage Encounter?
Yes No
Do you have any special dietary restrictions?
Yes No
Please be specific:
Special Seating Requests or comments (Please be specific)
Subtotals: Dinner & Dance: Quantity   X  $100/couple =$  .00
Table for five (5) couples: Quantity   X  $475/couple =$  .00
Total Amount:
 $  .00 
Payment Method: Check    #:  Credit Card (Visa, Master Card)

Please reserve your place right away by contacting:
Ed & Nancy Poorbaugh at
678-682-9246 or worldmarriagedayball@gmail.com

 
 
"Love one another , as I have loved you"