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Home
About
Who we are
Gary’s Bio
Terms
Counseling
Restoring Your Marriage
PreMarital Counseling
Individual Counseling
Make Appointment
Forms
Adult Intake Form
Youth Intake Form
Wedding Request
Conferences
Content
Contact
Calendar
Trips
Store
Products
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Checkout
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Please enable JavaScript in your browser to complete this form.
Yes! We are excited that you will be our Officiant!
Requested Services
*
Wedding Ceremony ONLY
Rehearsal & Ceremony
Pre-Marital Counseling
Bride's Name
*
First
Last
Email
*
Cell Phone
*
Groom's Name
*
First
Last
Email
*
Cell Phone
*
REHEARSAL DETAILS
Is Rehearsal at the Ceremony Location?
*
Yes
No
REHEARSAL Date / Time
*
Date
Time
Rehearsal Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
WEDDING DETAILS
Wedding Date / Time
*
Date
Time
Venue Name
Do you have Wedding Planner / Coordinator?
Yes
No
Name of Planner / Coordinator
Ceremony Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
CONTRACTED SERVICES
CO Fee
Wedding Ceremony ONLY - $ 350.00
R&H Fee
*
Rehearsal and Ceremony - $ 600.00
Premarital Fee
*
Pre Marital Counseling - $ 400.00
Total
$ 0.00
Acknowledgement and Agreement
*
By submitting this form you are indicating you want Gary Layne to be the officiant at your wedding. You acknowledge and agree to pay the required deposit to hold the requested date with full payment required just prior to ceremony. You also acknowledge that there may be travel fees added to the final payment as discussed at an earlier time and verbally agreed upon.
Submit
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