Retrouvaille of Lansing at 4007 Wildwood, Lansing, MI 48910 US - Registration Form

Registration for the weekend of:
Email Address:
Husband's Information	Wife's Information
First Name: Last Name: Address: City: State: Zip: Home Phone: Best time to call: Alternative Phone: Best time to call: Email Address: Religion: Name of Church:	First Name: Last Name: Address: City: State: Zip: Home Phone: Best time to call: Alternative Phone: Best time to call: Email Address: Religion: Name of Church:
Date of your marriage:

Is this your first marriage?
Husband: Yes No	Wife: Yes No
Is either spouse seeing a counselor?
Husband: Yes No	Wife: Yes No
What is your current marital status?	Married   Separated   Divorced
Rooms preference? (rooms have double beds)	Double   Queen Smoking Non-Smoking
Hearing impaired, language, or literacy problems?	Yes No
Do you have any dietary restrictions?	Yes No
Where did you hear about Retrouvaille? (Note: If from family or friends, where did they hear about it?)