Pay for Seminar by Credit Card

REGISTRATION for Seminar

Pay for Seminar (Pre-Marital or Coupl'e Group) by Credit Card

Please complete form below and submit to Rod. The form will then direct you to the
"PayPal" page to purchase the Seminar via your major credit card.

Your name:
Partner's name:
Address:
City:
State: Zip:
Your E-mail:
Patner's E-mail:
Home phone:
Your Cellular phone:
Partner's Cellular phone:
Do you need a notarized certificate of attendance:
This certificate is for the TN marriage license and for the pre-marital seminar only.
Seminars - Please enter amount($100): $
Date of Seminar you want to attend:


How did you hear about this Seminar?
Please hit the SUBMIT button, it will then direct you to the next page to purchase via credit card. PLEASE NOTE THE AMOUNT YOU ARE PAYING BEFORE HITTING "Submit". (You will need to enter the amount with PayPal to pay by Credit Card).
T H A N K Y O U !