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GIFT CERTIFICATE . . . If you are interested in obtaining a gift certificate to give a couple to attend a Marriage Encounter weekend, please complete this request form, enclose your check and send it to the address below:

MADISON MARRIAGE ENCOUNTER

GIFT CERTIFICATE REQUEST

A request for a Gift Certificate in the amount of

$      (enclosed) is being made for the following couple.

Name: _________________________________

Address: _______________________________

City/State/Zip: ___________________________

Phone: (______)__________________________

The request is being made by:

Requester(s):

Address: ________________________________

City/State/Zip: ___________________________

Phone: (______)__________________________

Handling of the certificate(s) - Please check one:

____Send certificate to couple receiving the gift certificate.

___ Send certificate to requesters.

Madison Marriage Encounter

P.O. Box 44983

Madison, WI 53744-4983

(608-821-3175)