Pre Marriage Class Registration

Loving Couples Education Class Registration

We're glad you are taking this step to create a long, lasting relationship! We look forward to meeting with you!

Today's Date: * +

Wedding Date (if not yet married): +

Person #1 First and Last Name *

Email #1 *

Person #2 First and Last Name *

Email #2

Main contact Phone (including area code) *

This phone is a: *

home

cell

work

Yes please contact me with the next session dates and locations

How long have you been together? *

Choose an approximate date that you would like to start or attend your session(s). We will contact you to confirm the next starting date. * +

Please choose what type of class style you are registering for: *

*

Day Long Group Class

Private Session

Please select the class you are registering for: *

4-6 Private Sessions ($1250)

1 Day Class Style ($750)

Please choose your top 5 in order of what you would like to get out of this educational experience:

	Expectations and Perceptions of Marriage
	Reactions
	Our Parents
	Couple Exercises
	Communication and Conflict Resolution
	What we need to talk about
	Communication
	Resolving Conflicts
	Expectations in Marriage
	Money Matters Questions
	Recreational Activities
	Children & Parenting
	Friends & Family
	Who, what and when?
	Roles
	Family Background Similarities/Differences
	Religious Values / Practices
	Personality Concerns
	Sexual Relationship
	Asking and Listening
	Active listening skills

Please choose how you heard about us. *

If you were referred to us, who can we thank?

What do you hope to get out of our couples education class? Are you working on any current issues in your relationship that we should know about? Please let us know any information that may help us give you a more personal, meaningful experience. This is not counseling, and is not intended to replace medical treatment. This is an education course. *