Corporation Form MR | Married 4Real

Company Name

Website

Address

Leader/Contact Name:

Title/Role:

Email

Phone

When would you like to launch the program?

Month

Day

Year

How many employees/couples do you anticipate participating?

How many workbooks will you need?

Facilitation Preference:

We would like LeTroy & Christina to facilitate the program.

We would like to purchase workbooks only.

Program Format Preference:

Virtual (Zoom)

On-site (in-person)

Hybrid

What are the biggest challenges your employees face that impact work-life balance?

Has your company previously offered family or marriage support programs?

Yes

No

What outcomes would you like to see from offering Marriage Reconstruction?

Budget Awareness (optional):

We have a wellness/professional development budget in place

We need to propose this to leadership

Not sure yet

I confirm that the information provided is accurate.

I understand that pricing will be provided once book quantities and facilitation preferences are finalized.