Name  _______________________________________________________________________________
           Bride-To-Be
            _______________________________________________________________________________
           Groom-To-Be

Address: ______________________________________________________________________________

_____________________________________________________________________________________

Contact Person _________________________________________________________________________

Contact Phone #  (______)________________________________________________________________

Wedding Date: _________________________________________________________________________

Special Dietary Needs ___________________________________________________________________________

We are registering for this program at the recommendation of:

Pastor ________________________________________________________
Church ________________________________________________________

REGISTRATION DEADLINE:  2 WEEKS PRIOR TO THE EVENT

We are interested in registering for:

Format I:  One Day Retreat (check üone)                          Cost Per Couple $150

_____ Saturday January 30, 2010
           Faith Lutheran Church
           8 Sherwood Road
           Cockeysville, MD 21030
           (inclement weather date, February 6, 2010)

_____ Saturday March 20, 2010
           Saint Michael Lutheran Church
           9534 Belair Road
           Nottingham, MD  21236

_____ Saturday May 16, 2010
           Harundale Presbyterian Church
           1020 Eastway
           Glen Burnie, MD 21060
       
_____ Saturday July 10, 2010
           Grace United Methodist Church
           5407 N. Charles Street
           Baltimore, MD 21210
           
_____ Saturday September 18, 2010 - NEW LOCATION!
           Damascus United Methodist Church
           9700 New Church Street
           Damascus, MD 20872

_____ Saturday November 6, 2010
           Church of the Holy Comforter (Episcopal)
           130 W. Seminary Avenue
           Lutherville, MD 21093

____ Format II:                                                                       Cost  Per Couple $240
         One couple meets privately with a staff therapist for four one-hour sessions
          The content is the same as Format I.       
          Schedule the sessions through the Program Coordinator, Judith M. Venable,
          410-433-8861, ext. 116

Payment must accompany registration.  Cancellation Fee: $25
Make checks payable to PCSM and mail to: 
PCSM, For A Lifetime, 5407 N. Charles Street, Baltimore, MD 21210.

Confirmation of registration will be made by phone with receipt of registration. 
Directions and last minute instructions will be made by phone 1 week before the event. 
Any other questions or information please call 410-433-8861, extension 116.