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Registration Formeric2025-04-14T08:48:58-04:00

Mari Ministries Registration

Step 1 of 5

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Contact Details

Name
Email

Event Details

Date of Intensive you plan on attending
Payment type ($250 refundable)

Husband's Information

Husbands Name

Wife's Information

Wife's Name

Couple's Information

If separated, please note we typically room couples together. If this poses a problem, please call us to discuss prior to comitting to attend. Please list address of each person; otherwise your home address of the couple.
Address

Family Information

Is anyone else living in your home?
Are any family members currently involved in counseling? In the past?
Do you, or a family member, have any currently diagnosed medical conditions (e.g, infections, diseases, chronic pain, high blood pressure, mental diagnosis, etc.)?
Are either of you currently taking medications?
Is anyone else in your home currently taking medications?

Intensive Dietary Requests and Restrictions

This section is to aid our Food Service staff as they prepare to serve you as our guest. While we will strive to meet your necessary dietary requests, please note we are nonprofit with limited resources. Accordingly, each guest is to assume personal responsibility for their dietary needs and communication of these needs. If we do not feel that we can safely accommodate a guest's requests, they may be asked to provide their own food. We are not a dedicated food facility and process all types of foods in the same kitchen.
Do either of you have any dietary restrictions that need considered for the intensive?
Please indicate below if you wish to request any dietary adjustments, including noting any food allergies.

1003 E State Avenue
Terra Alta, WV 26764

marriageistough@gmail.com
(304) 506-7479

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