Family Builders Ministries
Marriage Mentor Training Seminar
REGISTRATION FORM May 21-22, 2010
Alton Bay Christian Conference Center
Alton Bay, New Hampshire A completed form is required for each couple registering. Name __________________________________________________________________________Spouse Name _____________________________________________________________________ Address__________________________________________________________________________City ______________________________________ State _________ Zip ______________________ Home Phone (______)___________________ Email ______________________________________Church Name _____________________________________________________________________ Church Address ____________________________________________________________________City ______________________________________ State ___________ Zip ____________________ PAYMENT (check appropriate box): o Early-Bird Registration: First Couple from a Church by May 1: $249 per couple o Early-Bird Registration: Additional couple(s) from same church by May 1: $149 per couple o First Couple from a Church after May 1: $299 per couple o Additional couple(s) from same church after May 1: $199 per couple o Lodging and Meals Package: $140 per couple Total Amount Enclosed: $_______________ o Check (Payable to "Family Builders Ministries") o Credit Card (circle one): MasterCard Visa Discover American Express Card # ____________________________________________ Exp. Date __________ 3 or 4-Digit Security #______________________ Print Name on Card ____________________________________________________ Signature _____________________________________________________________ Mail to: Family Builders Marriage Mentor Seminar, PO Box 274, Cape Neddick, ME 03902-0274
Fax to: 1-207-361-1059 For more information call 207-361-1030.
| 
