ROM19 PMRC Registrations - Marriage Resource Centre

Registration Category

Please select the option that best applies to you:

ROM19 Speaker
Sponsored Delegate
Previous ROM Speaker
ROM19 Staff
SmartLoving Delegate/Guest

Is your spouse attending with you?*

Yes
No

Your Name*

Prefix First Last

Organisation

Role*

Please select the category that best describes your role.

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouse Details

Your Spouse's Name

Prefix First Last

Email

Attendance

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Days attending

Please select the days which you are attending.

Days Attending...*

Please select the days you are attending

Friday July 26, 2019 - day
Friday July 26, 2019 - dinner
Saturday July 27, 2019 - day

Dietary Requirements

If you have additional requirements please fill out the special requirements box below.

Gluten Free
Dairy Free
Vegetarian
Vegan
Nut free

Special Requirements or needs

Would you like to make a donation?

If you require a tax deductable receipt, do not enter your donation here. Rather, please click the 'Give Now' button at the top of the page AFTER you have submitted your registration.

Donation Amount $

All donations gratefully accepted

Total

$ 0.00

Credit Card

American Express

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Visa

Card Number Expiration Date Security Code Cardholder Name

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Renaissance of Marriage 2019 – Guest Registration

Spouse Details

Attendance

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