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Marriage Enrichment Seminar Registration

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  Couple's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Home Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  If chilcare is needed, please complete the information below:
  
  Childcare
  
  Number of Children REQUIRED Please fill out this field.
  
  Name of Child 1
  
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Child 2
  
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Child 3
  
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Child 4
  
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Child 5
  
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender Male Female
  
  Age Please enter valid data.
  
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- Confession follows from 4:00-5:00 p.m.

Church of the Holy Family

Catholic Church

Marriage Enrichment Seminar Registration

Confession follows from 4:00-5:00 p.m.