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Marine Forces Reserve CREDO Registration

Marriage Enrichment Retreat (MER) Leadership & Personal Development Workshops

Personal Development Retreat (PDR) Immunity to Change (ITC)

Leading from the Nexus (Four Lenses)

Applied Suicide Intervention Skills Training (ASIST)
Outward Mindset (Arbinger)
Suicide Alertness for Everyone (safeTALK)
Other:_________________________

Desired Event Date: _______________________ Location: __________________________________

MILITARY MEMBER INFORMATION: (Please print legibly) DOD ID #: _______________

Select One
Last Name: _______________________________ First Name: ____________________ MI: ____ Gender: ________

Preferred Name for Nametag (if different from first name): _______________________

Branch of Service: ______________________

Select One Status: _____________
Select One Rank/Rate: __________ Yrs of Svc: __________

Command: _________________________________________________ Work Phone: ________________________

Cell Phone: ______________________________ E-Mail Address: _________________________________________

SPOUSE INFORMATION (Marriage Enrichment Retreats ONLY; otherwise, please use one registration form per participant):

Select One
Last Name: ______________________________ First Name: ____________________ MI: _____ Gender: _________

Preferred Name for Nametag (if different from first name): _______________________

Branch of Service: ________________________

Select One Rank/Rate: ___________ Years of Service: ____________________

Permanent Command: _____________________________________________ Work Phone: ___________________

Cell Phone: ______________________________ E-Mail Address: ________________________________________

Date of Marriage: _________________________

Allergies or Dietary Restrictions: ____________________________________________________________________

EMERGENCY CONTACT: Name: _____________________________ Relationship: _____________________

Cell Phone: _____________________________________ Work Phone: ___________________________________

MARINE FORCES RESERVE: Are you directly attached to any part of MARFORRES? Yes No

* * * Command Endorsement Information Required on Next Page * * *

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COMMAND ENDORSEMENT:

My command has given me permission to attend this event: Yes No

Rank and Name of Supervisor (E7 & above): __________________________________________________________

Supervisor phone: ____________________ Supervisor’s e-mail: ________________________________________

COMMAND CONTACT INFORMATION:

Commanding Officer (CO) Name: ___________________________________________________________________

Commanding Officer (CO) Email: ___________________________________________________________________

Command Senior Enlisted Name: __________________________________________________________________

Command Senior Enlisted Email: __________________________________________________________________

NOTE: It is the Department of Defense’s policy to treat all married military couples equally. Marriage Enrichment
Retreats are open to all legally married military couples with spouses ID. The goal of these retreats is to strengthen
relationship skills in an environment that is free from the everyday distractions of life. Participants, Chaplains, and
support personnel in these retreats may have religious views that differ from your own religious views. Chaplains
conduct retreats in a manner that is sensitive to the diverse religious, spiritual, cultural, and beliefs of the
participants and in accordance with their own faith traditions.

Please call or email your questions to the CREDO office at (504) 697-8092 – mfr_retreats@usmc.mil

REGISTRATION: To register for a CREDO event:

Email all completed forms to: MFR_Retreats@usmc.mil (preferred)

Fax all completed forms to 504-697-9772, Attn: CREDO Coordinator
Registrations accepted in the order received.
Wait list priorities will be MFR Personnel on a first come, first serve, and case-by-case basis.

PRIVACY ACT STATEMENT

Under the authority of 5 U.S.C. 301 (department regulations), the above requested information is used for keeping
record of all personnel who participate in the CREDO program. The above information will create a roster for use
before, during, and after your retreat. Furnishing this information is encouraged but not mandatory. Photos for
historical record and promotion of CREDO are taken during retreats. If you do not want your picture taken or
shared, please inform the CREDO staff upon your arrival at your retreat.

Signature: ________________________________________________ Today’s Date: _______________________

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