His Name:   Her Name:
Last Name:  
Address:   City:  
Zip:    
Phone:   Alternate Phone:
Email:    
His Faith: Her Faith:
Parish: Wedding Date:
Weekend:  
Referred by:
Special Comments:
Payment Method:
  • Pay by Check
    • Make checks payable to World Wide Marriage Encounter.

      Send $55 registration check to:
      WWME
      C/O John and Lori Lorg
      11324 Rene St
      Lenexa, KS 66215
  • Pay by Credit Card
    • All Credit Card Fields Must Be Completed.

      Credit Card: Name on Credit Card:
      Credit Card Number:
      (Provide full credit card number
      to ensure proper processing.)       		Expiration Date: /