Couples Registration

Partner 1 Information:

Name*

Contact Information*

Street AddressCityStateZip Code

Preferred Phone number*

Phone Type

Email*

Alternative Phone number

Phone Type

Date of Birth*

Gender*

Occupation

Have you been legally married before?*

When was your divorce final?

If Jewish, Hebrew name (if known)

Parents’ Hebrew name(s) (if known)

Your responses to the following questions will help Rabbi Field learn more about your background and your goals for your wedding ceremony.

Please describe your religious/cultural background:*

How do you relate to that today?*

How do you foresee relating to that in the future?*

What have been some significant milestones in your religious/cultural journey?*

Partner 2 Information:

Name*

Same Address as Partner 1 above?

Yes
No

Contact Information*

Street AddressCityStateZip Code

Preferred Phone number*

Phone Type

Email*

Alternative Phone number

Phone Type

Date of Birth*

Gender*

Occupation

Have you been legally married before?*

If so, when was your divorce final?

If Jewish, Hebrew name (if known)

Parents’ Hebrew name(s) (if known)

Your responses to the following questions will help Rabbi Field learn more about your background and your goals for your wedding ceremony.

Please describe your religious/cultural background:*

How do you relate to that today?*

How do you foresee relating to that in the future?*

What have been some significant milestones in your religious/cultural journey?*

Ceremony Information

Date

Time

Number of Guests expected

Location (include address)

How did you learn about JYW / Rabbi Brian?

Please tell us about any planned name changes (if applicable) after the wedding.

Payment for Services

If you have already confirmed your wedding date and payment amount with Rabbi Brian, you may submit a deposit here. You may also pay by check. Please contact Rabbi Brian with any questions.

Your payment amount:

Other amount:

When you click on Submit, you will be taken to a secure PayPal page. You do not need a PayPal account to pay by credit card. You will receive email confirmations from both JYW and PayPal.