COUPLE CONNECT NIGHT

Your Name

Spouses Name

This address will receive a confirmation email

Phone

Address

There will be childcare available for ages 5 & under (pre-registration for childcare is required- No onsite check-ins allowed) Please indicate if you will register any children for Childcare.

No Childcare needed Yes, I will use childcare

If using Childcare, please list child's names and ages:

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Friday, February 13th (6-8:30pm)

Please fill out this form and click submit.

Event held in the MultiPurpose Room and includes a catered meal.

DEADLINE: SUNDAY, FEBRUARY 8, 2026

COUPLE CONNECT NIGHT

Description

Please Fix the Following