*
= Required Field
His Name
*
:
Her Name
*
:
Contact Name & Address
*
:
Phone Number
*
:
His Phone Number
Her Phone Number
E-Mail Address:
His Email Address
Her Email Address
Intended Wedding Date (Date/Month/Year)
*
:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
2012
2013
Weekend Desired
*
:
Husband's Religion:
Catholic
Other
Wife's Religion:
Catholic
Other
Where did you hear about Engaged Encounter?:
Other comments or special needs:
Please send booking deposit (non refundable) of £50 (or Euro equivalent) to:
Engaged Encounter
c/o 19 Manor Road,
Magherafelt,
Co.Derry.
BT45 6QF
click here
