Please enable JavaScript in your browser to complete this form.Name *FirstLastCurrent PositionChurch / OrganizationEmail *Phone *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhere are you active in a Faith community? *How did you hear about this training? *Are you currently involved in any counseling ministry? If yes, where and in what capacity? *What is your goal or expectation from this training? *This is a ten week course that meets on Wednesday nights at Lakeview Bible Church (4825 Grape Creek Road) January 19th through March 30th, taking March 16th off for Spring Break, from 7-9pm and will include one all-day Saturday class from 9-4 on March 26. Are you committed to attending most/all sessions? *YesNoAnything else we should know?Registration PricePrice: $ 225.00Stripe Credit Card *CardName on CardSubmit