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Worldwide Marriage Encounter
MA / RI / NH Area

Preliminary Application Form

To attend a Worldwide Marriage Encounter,
please fill out this application form.

Please use TABs or mouse clicks
to move from field to field.

Husband first & last name:
Wife first & last name:
Street Address:
City:
State:
Zip Code:
Home Phone Number (include area code):
Mobile Phone Number (include area code):
Work Phone Number (include area code):
Your Email Address:
Alternate Email Address:
Your Wedding Date:
Which weekend date would you like to attend?
Please select an alternate date:
Number of children:
Husband's Religion and
Parish/Church (including town):
Wife's Religion and
Parish/Church (including town):

How, or from whom, did you hear about the weekend?

If you experience any trouble with this form, please send email to:

A $50 non-refundable application fee is required to confirm your application. New! If you apply for your Weekend 4 weeks or earlier before its start date, take a 20% discount off the application fee. Save $10! (For early applicants, send a check for $40, or indicate a $40 payment on your credit card form; if you pay with PayPal, you will be refunded $10. Payment must be received 4 weeks prior to the weekend start date.)

Payment options:

1) Send a check (payable to "Worldwide Marriage Encounter") to:

Ralph & Jane Becker
28 Field Pond Rd
Milford, MA 01757

2) Pay with any major credit card; Click here to download the form. Fill out completely and mail to the same address.

3) PayPal. After you submit the form above, you will be given the option to pay via PayPal.

Contact for more information:

800-710-WWME (or 978-870-5646)

You can also click here for a printable application form, fill it out, and mail it with your application fee to the same address.

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Last updated January 28, 2012
Copyright © 2002-2011 by Ralph & Jane Becker < >, All Rights Reserved
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