Couples Retreat Registration Form

For more information about the Couples Retreat, including dates, locations, cost, FAQs, and more, please visit our Couples Retreat information page.

Contact Information

Your First Name *

Your Last Name *

Your Email Address *

Your Phone Number *

Partner First Name *

Partner Last Name *

Partner Email Address *

Mailing Address

Please provide your home address. We will be mailing you books and reading material in advance of the couples retreat.

Address (Line 1) *

Address (Line 2)

City *

State *

Zip Code *

Retreat Selection

Rooms are reserved from Friday to Sunday. If you arrange your own lodging or stay at home, you'll receive a $150 discount, reducing your third payment to $100.

First Selection for Dates *

Primary Location *

In case your primary selection is full, please select a backup date.

Backup Dates *

Backup Location *

Referral Information

How did you find out about the Couples Retreat? *

If other, please specify.

May we contact the person that referred you and thank them? If so, please provide their name and email address below.

Referrer Name

Referrer Email

Background Questions

Are you currently married? *

Yes, we are married

Engaged to be married

No, we are not married and not engaged

How Long have you been together?

Why do you want to attend the couples retreat? *

Rate the Following

Rate the following as areas of need: Select 1 for "we are absent of this or completely in need of rebuilding" and 7 being "we are masters in this or need no help here".

We're best friends and know each other's love language or ways *

We communicate well even with the most difficult topics and moments *

We are very intimate and have great sensual and sexual co-existence *

We manage conflict well, always considering the relationship first *

We share a future vision together *

We are spiritually connected *

We contribute to each other's individual values and goals *

We have trust and honesty *

We are emotionally self regulated individually even in the tough moments

We are active in family relationships including in-laws *

Additional Comments

Comments or other information

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Couples Retreat Registration Form

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