Northeast Kansas Marriage Encounter
Section 9
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His Name:
Her Name:
Last Name:
Address:
City:
Zip:
Phone:
Alternate Phone:
Email:
His Faith:
Her Faith:
Parish:
Wedding Date:
Weekend:
Select Weekend
Feb 13-15, 2009
April 24-26, 2009
July 24-26, 2009
Sep 25-27, 2009
Dec 4-6, 2009
Referred by:
Special Comments:
Payment Method:
Check
Credit Card
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:
Select Credit Card
MasterCard
Visa
Name on Credit Card:
Credit Card Number:
(Provide full credit card number
to ensure proper processing.)
Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2008
2009
2010
2011
2012
2013
2014