Please fill out this form and, print it and mail it with your check or money order of $300 to our home office at this address.  We also except credit cards in person or over the phone. (PayPal too)

              Medina Wedding Chapel
              N853 Julius Drive                
              Appleton, WI  54914-9197

Please call or text us at (920) 707-6250 or e-mail us at to confirm that the date you have requested is available before sending in your deposit.  The chapel is available for weddings from mid April thru mid November. The chapel is available for tours anytime of the year.  Call for an appointment.

Today’s Date:
E-Mail Address:
Names (Bride & Groom):
Street Address:
City, State, Zip:
Home Phone:    Cell Phone:
Wedding Date:   Day of the week:
Time of Ceremony:
Rental Hours: We would like to reserve the chapel from   to 
For example: You might have a 3:00 ceremony and rent the church from 2:00 to 4:30
We will locate a pastor/judge for your wedding. Which would you prefer? 



Your Wedding Ceremony at the Medina Wedding Chapel


3 piece Unity Candle set ($25)

Aisle Runner ($20)

Window Candles 16 pcs ($30)

Sand Ceremony Unity Kits ($30-$40)



5% Wisconsin sales tax


Subtract $300 non-refundable deposit to reserve date


Balance due

Balance must be paid one week before ceremony          Date due

Note: If this page is sent by mail, a confirmation letter will be sent back to you showing deposit paid, balance due, date due, wedding date and time, and any options you may have added. If it is returned in person, a copy will be made of this page at that time for your records.