MarriedMinistryRegForm

North River Dynamic Marriage Registration Form

Please fill out the form below to register for the next upcoming Dynamic Marriage class.

Payment for the class is due at the first class meeting!

Date(MM-DD-YY) *

Husband's Name(First,Last) *

Wife's Name(First,Last) *

Street *

City *

State *

Zip Code *

Husband's (or Family's) Email Address *

Home Phone (xxx-xxx-xxxx) *

Husband's Cell Phone

Wife's Email Address

Wife's Cell Phone

Member of North River Church of Christ

What is your level interest in the Dynamic Marriage ministry (choose one)? *
Participate in the first upcoming class
Participate in a class in the future
Interested in becoming a Facilitator
Been through the Dynamic Marriage class in the past
Been a facilitator for a Dynamic Marriage class in the past
Not sure, but want to know more

How Long have you been married (in years, numbers only)? *

Names & ages of children

Husband: On a scale from 1 to 10, How happy are you with your marriage right now? (1 = not at all, 10 = extremely)

Wife: On a scale from 1 to 10, How happy are you with your marriage right now? (1 = not at all, 10 = extremely)

(If your form submisson is accepted, you will get the following message: Your Dynamic Marriage Registration was received successfully. You will also receive an email acknowledgement once your Registration is processed.)