Personal Information
Last Name
First Names
His

Hers
Address
City
Province / State e.g. NY
Postal Code / Zip Code e.g. 123456
Wedding Date yyyy-mm-dd
Church currently attending
E-mail Address
Home Phone
Cell Phone
Work Phone
Recommended by
(couple who attended a weekend)
Weekend Options
Date/Location
Can attend on short notice or not
His Physical Needs
Her Physical Needs
Room Choice no smoking smoking
Dietary Needs
Application Fee ($50)   cheque  credit card
If paying by credit card, please call the appropriate Application couple (listed below) with credit card number and expiration date or pay online using PayPal when prompted. To pay by check, make checks payable to Covenant Encounters then address your envelope to the application couple below.

Application Couple
Nolan and Dorenda Van Gaalen
480 4th Ave SE
Sioux Center, IA 51250
712-722-4022
tri-state_registration@reformedme.org