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Pre-Marital Care Application
Apply for Pre-Marital Counseling
Please complete this form. If you already have an account, please
log in
first.
PMC
First Name
First Name is required.
Last Name
Last Name is required.
Email
Email address is not valid
Email is required.
Mobile Phone
Wedding Date
Wedding Date is required.
Date of Birth
Date of Birth is required.
Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Are you a member?
Yes
No
Not Sure
Are you a member? is required.
Fiance's Name
Fiance's Name is required.
Fiance's Date of Birth
Fiance's Date of Birth is required.
Fiance's Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Fiance's Phone
Fiance's Phone is required.
Is your fiance a member?
Yes
No
Not Sure
Is your fiance a member? is required.
Are you in a community group? If yes, please let us know which group. If no, please tell us why not.
Are you in a community group? If yes, please let us know which group. If no, please tell us why not. is required.
Is your fiance in a community group? If yes, please tell us which group. If no, please tell us why not.
Is your fiance in a community group? If yes, please tell us which group. If no, please tell us why not. is required.
Please share any significant past experiences—family life, relationships, circumstances or events—that might require special attention during PMC.
Please share any significant past experiences—family life, relationships, circumstances or events—that might require special attention during PMC. is required.
Have either you or your fiance been married before? If yes, please elaborate with dates and details about your circumstances.
Have either you or your fiance been married before? If yes, please elaborate with dates and details about your circumstances. is required.
When are you available to meet for pre-marital counseling? (Please be flexible, as our counselors have busy schedules. We'll do our best to find a time that works for us both.)
Sunday morning
Sunday afternoon
Sunday evening
Monday morning
Monday afternoon
Monday evening
Tuesday morning
Tuesday afternoon
Tuesday evening
Wednesday morning
Wednesday afternoon
Wednesday evening
Thursday morning
Thursday afternoon
Thursday evening
Friday morning
Friday afternoon
Friday evening
Saturday morning
Saturday afternoon
Saturday evening
When are you available to meet for pre-marital counseling? (Please be flexible, as our counselors have busy schedules. We'll do our best to find a time that works for us both.) is required.
Any special considerations regarding scheduling that we need to know about?
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