Required fields are marked with asterisks (*)

Marriage Commissioner Booking Form

Applicants

Name of 1st Applicant (Last name, First name):

Name of 2nd Applicant (Last name, First name):

Primary Contact

Primary Contact will be:

Address of Primary Contact:

Phone Number of Primary Contact:

Additional phone number(s) (if applicable):

Email Address of Primary Contact

Please provide details if the individual serving as the primary contact is other than one of those getting married:

Wedding Information

Date of Wedding (Month/Day/Year):

Approximate time of wedding:

Location of Wedding (Specify as exact an address as possible):

Date of Rehearsal (if applicable):

Which Marriage Commissioner would you like to conduct your ceremony?

Cathy Addison

Peggy Van Mierlo-West

No preference (we will assign you a commissioner)

Travel and Rehearsal fees if applicable may apply (paid directly to chosen commissioner)

Privacy Statement: The personal information contained on this form is collected under the authority of the Municipal Act 2001 P.S.O. c45 and will be used for the purpose of administering Civil Ceremonies for the Clerk’s Department of the Municipality of Northern Bruce Peninsula. Questions about the collection of this information can be directed to the Clerk, Municipality of Northern Bruce Peninsula, 56 Lindsay Rd. 5, Lion’s Head, Ontario, N0H 1W0 Telephone: 833-793-3537