Victoria Catholic Diocese Engaged Encounter Retreat

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To register for an Engaged Encounter weekend please print this form and fill it out by typing or printing the information legibly.    
Couple Information:

His Legal Name :_____________________________________________________________  Name Tag Preference:_____________________________________       Age:_________
Address:_____________________________________________________________________
City__________________ State:_____________  Zip:____________ 

Email ______________________________________________________
Home/Cell Phone #:(________)____________________    

Work/Cell Phone #:(_________)_________________
Priest/Pastor:_______________________________    Religion:___________________________
Church Name/City__________________________________________
Parent's Address_______________________________________________
City__________________ State:___________________ Zip: ________________________

Do you have any children? _______________
Parent's Phone #:(_________)_________________________

Special Needs__________________________________________________________________


Her Legal Name:____________________________________________________________  Name Tag Preference:_____________________________________       Age:_________
Address:_____________________________________________________________________
City__________________ State:_____________  Zip:____________ 

Email ______________________________________________________
Home/Cell Phone #:(_________)________________________
Work/Cell Phone #:(________)________________________
Priest/Pastor:_____________________________________
Religion:_____________________________________

Church Name/City_____________________________________________________________________

Parent's Address_____________________________________________________________________
City__________________ State: ____________  Zip: _______________
Do you have any children? _______________
Parent's Phone #:(_________)_________________

Special Needs__________________________________________________________________


Wedding Date:______________________ Parish/City:_____________________________________________

Weekend Choices- Enter the weekend dates of your choice in order of the most desired:
1st__________________________    2nd:________________________   3rd:___________________________

Make cashier's check or money order payable to: "Engaged Encounter" for $210 (if wedding will occur within the Diocese of Victoria) $265 (for all other Dioceses).

Sorry, Personal Checks Cannot Be Accepted.
Mail completed form and check to:

Engaged Encounter
P.O. Box 4070
Victoria, Texas 77903

Sorry, we do not accept online registration. If you have questions you may call (361) 573-0828 ext. 2230.

 

 

OFFICE USE ONLY:

          Cash $___________      Cshr Ck / Mny Ord $_____________

           _______________________________________________

          CC $____________     Code:__________     ZIP:____________

            ________________________________    Exp:__________

          Confirmation Letter Sent:_____________________________