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St. Agnes Catholic Church
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DivorceCare Registration Form
The registration fee is $20.00. The fee includes the workbook and covers all 13 sessions, plus the additional session on "the annulment process" if interested. Child Care is not provided.
First Name:
*
Last Name:
*
Email Address:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Telephone Number
*
Date of Birth (month/day)
*
Separated / how long? If not applicable put NA
*
Divorced / how long? If not applicable put NA
*
Payment will be mailed to Jacque J. Neu - P.O. Box 761 - Scottsbluff NE 69363 (put an x if applicable)
Or
I'll bring it to the first meeting (put an x if applicable)
Or
Please cover my registration from the scholarship fund (put an x if applicable)
Do not enter anything in this field:
*
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Saint Agnes Catholic Church
2314 Third Avenue
Scottsbluff, Nebraska 69361
PH: 308.632.2541
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