Tidewater Pastoral Counseling Services

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2012 Dates:

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Please complete the following:
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
PARTNER's NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
MARRIAGE DATE:
CHURCH AND LOCATION:
REFERRED BY (SO WE MAY NOTIFY YOUR OFFICIANT WHEN YOU COMPLETE THE COURSE):
EMAIL (PLEASE PROVIDE IF WE MAY CORRESPOND WITH YOU VIA EMAIL):

This form is a work in progress. Pressing Submit will submit your information to TPCS although the confirmation page may not come up. Thank you for your patience while we work to improve our site.

An email will be sent to the email address you provided with your registration confirmation and further instructions. If you do not receive your confirmation within 3 business days please contact the office at 757-623-2700. Please note, confirmation will only be sent out after registration AND payment have been processed. If you did not provide an email and wish to be contacted through USPS mail, the instruction letter can be mailed (please allow extra time for this).