Couples’ Summit 2013


Come join other couples, improve your marriage, and connect with other members of North Star and make lasting memories. We provide an environment of open discussion to help improve our marriages and ourselves while having fun!

Who is invited?

ANY married or engaged couple desiring to improve their marriage is welcome to participate! The great thing about the Couples’ Summit is it provides a place for a couple to do their work TOGETHER! Furthermore, while the topic of same sex attraction is welcome, and does come up, it is certainly not the focus of the event, your marriage is! The monetary and time commitments are minor in comparison to what you will leave with.

Please note all of the same rules you agreed to when joining North Star will apply and everyone will be required to sign confidentiality agreements.

What can we expect?

The goal of the Summit is to provide a place for couples to work on communication skills, trust, and healthy emotional connection. This is our fifth year anniversary, and to celebrate, we are extending the Summit to also include a dinner in Friday night. Saturday is a full day of ropes course work, where trained professionals help ensure safety of all participants. Their is no couple too old or too young to participate, and all couples, regardless of shape or size are welcome! We also have skilled team leads, from our community, who lead informative, productive discussions following each activity.

When and where will it be?

  • Friday evening, August 2 &
  • All-day Saturday, August 3
  • Provo, Utah

How much does it cost?

  • Earlybird special: $140.00 per couple
  • Standard price: $165.00 per couple


Registration

Step 1: Register Now

(REMINDER: This event is for husbands and wives or engaged couples only.)

Registration Form
Husband’s Name*
 Wife’s Name*
Name on Name Tag*
 Name on Name Tag*
Date of Birth*
 Date of Birth*
Date of Marriage*
Street
City
 State
 Zip
Phone* (Home)
E-mail Address*
Signature: By checking this box you verify that the above information is accurate.

Confidentiality Agreement

I agree to forever keep confidential all names and identifying information of those participating or presenting at the Couple’s Summit.

I agree to forever keep confidential any and all aspects of what others experience this weekend and anything they may choose to disclose about themselves, their lives and their feelings.

I am, however, free to share with others in my life my own feelings about the weekend, what I experienced, and what I learned, as long as I do so without violating my commitments to confidentiality as noted above.

IMPORTANT EXCEPTION: MANDATED REPORTERS – Certain individuals may be participating in the weekend who may be designated, by the legal requirements of their profession, as “mandated reporters” of suspected abuse. Their obligations under the law about certain specific disclosures take precedence over this confidentiality agreement. This means, for instance, that if someone participating in the Couple’s Summit discloses that they have abused a child at any time in their past, a mandated reporter will be legally required to report this disclosure to legal or child-protective authorities. This requirement does not apply to disclosures by adults of having been abused as a child, only to disclosures of having been the abuser. Mandated reporters must adhere to all other aspects of this confidentiality agreement that are not specifically superseded by mandated-reporter requirements.
Signature: By checking this box you agree to the terms of the Confidentiality Agreement above.

Questionnaire

  1. May we contact you at the above location if needed?
    Yes No

  2. Please provide an emergency contact name and phone number. This should be someone who can act in your behalf in case you were to need emergency health care assistance over the weekend.

    • Emergency contact name:
    • Emergency contact phone number:

  3. Do you have any special dietary needs?
    No Yes, I eat vegetarian only Yes, other (Please explain)

  4. Do you have any physical or health limitations?
    No Yes (Please describe.)

  5. How did you find out about the Couples’ Summit?

If you have other questions or concerns, please contact lostbyuguy@gmail.com. Thank you.


 

Step 2

Click below to pay the $140 early-bird registration fee.

Sponsor a Couple

If you would like to make a donation to our scholarship fund in order to help another couple come that might not othewise be able to do so due to financial difficulties, please click below.


Apply for a Scholarship

Scholarships will be awarded up to half the cost of the conference. A limited number of scholarships are available and are based on financial need and available funds.

To apply for a scholarship:

Step 1: Complete Registration Form Now

(REMINDER: This event is for husbands and wives or engaged couples only.)

Registration Form
Husband’s Name*
 Wife’s Name*
Name on Name Tag*
 Name on Name Tag*
Date of Birth*
 Date of Birth*
Date of Marriage*
Street
City
 State
 Zip
Phone* (Home)
E-mail Address*
Signature: By checking this box you verify that the above information is accurate.

Confidentiality Agreement

I agree to forever keep confidential all names and identifying information of those participating or presenting at the Couple’s Summit.

I agree to forever keep confidential any and all aspects of what others experience this weekend and anything they may choose to disclose about themselves, their lives and their feelings.

I am, however, free to share with others in my life my own feelings about the weekend, what I experienced, and what I learned, as long as I do so without violating my commitments to confidentiality as noted above.

IMPORTANT EXCEPTION: MANDATED REPORTERS – Certain individuals may be participating in the weekend who may be designated, by the legal requirements of their profession, as “mandated reporters” of suspected abuse. Their obligations under the law about certain specific disclosures take precedence over this confidentiality agreement. This means, for instance, that if someone participating in the Couple’s Summit discloses that they have abused a child at any time in their past, a mandated reporter will be legally required to report this disclosure to legal or child-protective authorities. This requirement does not apply to disclosures by adults of having been abused as a child, only to disclosures of having been the abuser. Mandated reporters must adhere to all other aspects of this confidentiality agreement that are not specifically superseded by mandated-reporter requirements.
Signature: By checking this box you agree to the terms of the Confidentiality Agreement above.

Questionnaire

  1. May we contact you at the above location if needed?
    Yes No

  2. Please provide an emergency contact name and phone number. This should be someone who can act in your behalf in case you were to need emergency health care assistance over the weekend.

    • Emergency contact name:
    • Emergency contact phone number:

  3. Do you have any special dietary needs?
    No Yes, I eat vegetarian only Yes, other (Please explain)

  4. Do you have any physical or health limitations?
    No Yes (Please describe.)

  5. How did you find out about the Couples’ Summit?

If you have other questions or concerns, please contact lostbyuguy@gmail.com. Thank you.

Step 2: Pay the required deposit of $50.00.


(You must complete the conference registration form, make the required deposit of $50.00, and fill out the scholarship application in order for your request to be considered. If you do NOT receive the financial assistance you need, and you therefore need to withdraw your registration, your deposit will be fully refunded to you.)

Step 3: Complete the scholarship application.

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