Friends Couple Enrichment - Registration Form
Use this form to register for the workshop being led by John and Debbie Humphries. You'll find more information about Friends Couple Enrichment at www.friendscoupleenrichment.org

February 1, 2020
9:00am-5:00pm (please plan to arrive at 8:30 to complete registration, get materials and settle in)
All Souls Unitarian Universalist Church
19 Jay St, New London, CT
Partner 1 First Name (name you want to be called) *
Your answer
Partner 1 Last Name *
Your answer
Partner 1 E-mail *
Your answer
Partner 2 First Name (name you want to be called) *
Your answer
Partner 2 Last Name *
Your answer
Partner 2 E-mail *
Your answer
Please provide a phone number where we can reach you, if needed. *
Your answer
Where do you live (town and state)?
Your answer
Have you ever participated in a Couple Enrichment event (or similar program) before? *
If you answered "yes", please tell us when you participated in that event (and perhaps a sentence about the experience).
Your answer
How long have the two of you been together? *
Your answer
What is the family constellation in your home? (e.g. children at home? blended family? caring for elders at home or nearby?) *
Your answer
What are you hoping to experience during this event?
Your answer
Friends Couple Enrichment workshops are open to people of all faiths and people who are not religious, but the workshops do have a "Quaker flavor." Please tell us what faith community (if any) you are part of.
Your answer
Does either of you have physical restrictions we should be aware of (e.g., trouble with stairs, dietary allergies/restrictions, limitations with vision or hearing, etc.)?
Your answer
Is there anything else that you think would be helpful for us, as leaders, to be aware of as we pray and prepare for this event? Anything you share here will be held in confidence.
Your answer
CHILDCARE: All Souls Congregation will be providing free childcare for anyone who needs it. If you will be bringing children, please tell us how many children and their ages. All Souls will follow up separately to get more details about your specific needs.
Your answer
The cost for the program is $50 per couple, payable by check or cash on the day of the event. ($20 is the fee specified by the Friends Couple Enrichment organization for a one-day program. The other $30 will cover food and materials for the day.) Scholarship funds are available for those who need them. If you are unable to cover the full cost, please specify how much you are able to pay in the "Other" field. *
Thank you!
We look forward to being with you on February 1st!

We will send additional logistical details during the week prior to the event.

With appreciation,
John & Debbie
jhumphries@igc.org; 860-216-7972
dhumphries@igc.org; 860-904-8428
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