To the Moon and Back Couples Dinner • Living Word Church

First Name *

Partner's Name *

Last Name

Dinner Selection (Person 1) *

Chicken Fettuccine Alfredo

Spaghetti and Meatballs

Dinner Selection (Person 2) *

Chicken Fettuccine Alfredo

Spaghetti and Meatballs

Do you intend to bring children for childcare? *

Yes

No

If so, please list number of children and children's ages

*Please note: Pizza will be provided for the children. If alternative food is needed, parents will need to bring food for your child(ren).

Couple Registration for Dinner 0