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Couples' Retreat Registration

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Couples' Retreat
Registration & Payment Form
We are excited that you plan to join us for the upcoming Couples' Retreat. Please submit the form below. You will have the option of paying online, or you are free to submit the form and turn in your payment after. If you choose to pay later, please mail or bring in your payment to the Kokomo Pastorate Office (located inside St. Joan of Arc), or leave in one of the secure drop boxes at St. Patrick Church (checked daily). If you have any problems or questions, please reach out to Chad Grube ([email protected]).
Deadline to register for the retreat is Friday, January 31st at noon.
Registration & Payment
This form is not accepting responses at this time.
- Husband name (first and last) REQUIRED Please fill out this field. Please enter valid data.
- Husband phone number REQUIRED Please fill out this field. Please enter valid data.
- Wife name (first and last) REQUIRED Please fill out this field. Please enter valid data.
- Wife phone number REQUIRED Please fill out this field. Please enter valid data.
- Do you text? REQUIRED Yes No Please fill out this field.
- Email address REQUIRED Please fill out this field. Please enter valid data.
- Home address REQUIRED Please fill out this field.
- Parish affiliation REQUIRED Please fill out this field.
- Wedding anniversary (MM/DD/YYYY) REQUIRED Please fill out this field. Please enter valid data.
- Food allergies, special accomodations, etc. REQUIRED Please fill out this field.
- Retreat registration cost100.0
Total:

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