1. *Full Name
2. *Spouses Name
3. Church⁄Organization
4. *Mailing Address
5. *City
6. *Zip Code
7. *State Alabama Alaska Arizona Arkansas California Colorado Conneticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missourie Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. *Country
9. *Telephone
10. Fax
11. *Email

Indicate break-out session interest (please choose two):

1. Victorious Finances (Success in managing your finances properly in marriage)
2. Victorious Come Back (Overcoming obstacles threatening the stabilityof the marriage. Working through past betrayal, personal perceptions and interpretations)
3. Victorious Secrets (Pizzazz your Boaz, Truth your Ruth. Keep flames burning w ⁄ intimacy)
4. Victoriously Blended (Discover practical solutions to your stepfamily challenges as two families become one)
5. Victorious Communication (Learning honest, healthy communication in marriage)

1. Please check here if you require a vegetarian lunch.
2. Please list any ADA Special Needs:

Fees for missed meals, late arrivals, and early departures will not be refunded. Fees will be refunded, less a $20 processing fee, if cancellation or change resulting in a refund is received in writing no later than August 1, 2010. After that date fees are non-refundable. All refunds will be processed after the conference. Substitutions are allowed at no charge.