of the Low Country - South Carolina


The Beginning Experience Ministries
Please fill in all fields!

Full Name: 

Preferred First Name: 

 
Address:  

City: 

State:  Zip:  
Home Phone:

Work Phone:

Email Address:
Age: How old are you?

Sex:

Male
Female
Status: Separated  Divorced  Widowed  -  How Long?
Marriage:   How long were you married? How many times?
Children:   How many? Ages: 
Weekend: Have you ever attended a TBE weekend before? Yes No
Church: Name of Church you attend:
Counseling
Therapy:
Are you currently in any Counseling or Therapy? Yes No
If so, name of Counselor or Therapist:
Counselor/Therapist Address: Address City State Zip
Carpool: Would you like to ride with the Carpool? Yes

No

How did you hear about the weekend?
Who do you know attending this weekend?
Whom to notify in case of Emergency:
(Enter full name, address and phone number(s))
 
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A weekend program designed to help people who are widowed,
 separated or divorced
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