| Form A |
| Minister's Name:
_______________________________________________ |
| Phone (H):
____________________
Phone (W): ____________________ |
| Address: |
______________________________________________________ |
|
______________________________________________________ |
|
| Church:
_______________________________________________ |
| Denomination:
_________________________________________ |
| Date of Ordination:
_____________________________________ |
| Licensed to perform weddings in Virginia by: |
________________________,
(jurisdiction) |
|
________________________.
(date) |
|
| Officiating at the wedding of: |
______________________________________
(names of couple) |
|
| Date and time of wedding:
________________________________________ |
| Date and time of rehearsal:
_______________________________________ |
| Pre-marital counseling will be conducted by: |
_________________________
(name of minister or counselor) |
|
| Signature of Minister:
____________________________ Date: _________ |