Couples Retreat September 29-October 1, 2017 at the Blue Gate Garden Inn, Shipshewana, IN with Rev. Dr. Todd Biermann Name of Couple: ___________________&______________________________________________ Husband
Wife
Last Name
Address: _________________________________________________________________________ Phone: ___________________________ E-mail: _________________________________________ Church: __________________________________________________________________________ Name
City, State
Wedding Anniversary ______ / ______ / ____________ As of September 29th we will have been married __________ years Briefly describe how / when you met each other __________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Do you have any special dietary needs? ________________________________________________ What type of wine do you prefer? (Please choose one) ____ Sweet White Registration Fee
____ Sweet Red ____ $75 / Couple
(Pay St. John) Make checks payable to
____ Dry White ____ $25 / Couple (Wyneken faculty/staff discount)
“St. John Lutheran Church”
____ Dry Red
Total: $
.
Memo: “Couples Retreat”
Accommodations We plan to stay... ____ 1 Night ($122) ____ 2 Nights ($244) ____ Saturday’s Seminars Only All hotel reservations need to be made by contacting the Blue Gate Garden Inn directly. Call 1-800-545-4725 and ask for the “St. John Lutheran” block. St. John Lutheran Church † Bingen www.stjohnbingen.com