A New Way To Love:
Living God's Purpose for your Marriage
Registration Form

Registration is a two step process. Step one is to make payment. Step two is to complete the registration form below.

You can pay the registration fees online through Google. You can also remit a personal check or money order to:

Dr. Tony Victor
6 Emerald Terrace
Suite 4
Swansea, IL 62226

When you have completed payment please return here to complete the Registration Form below.

Thank you. We are looking forward to meeting you.




A New Way To Love:
Living God's Purpose for Your Marriage
Registration
Please note that all fields followed by an asterisk must be filled in.
A New Way To Love:
Living God's Purpose for Your Marriage
2010 Training Sessions*
First Name*
Last Name*
E-mail Address*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Contact Phone*
Partner First Name*
Partner Last Name*
Partner E-mail Address
Partner Street Address*
Partner City*
Partner State/Prov*
Partner Zip/Postal Code*
Partner Contact Phone*
Special Needs--Comments or Questions
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Who can we thank for referring you to us.

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