Class Registration

Name *

First

Last

Current Position *

Church / Organization *

Email *

Phone *

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Where 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 Tuesday nights September 8-November 10 from 6:30-8:30 and will include one Saturday from 9:00-4:00, that date is TBD. Are you committed to attending most/all sessions? *

• Yes
• No

Anything else we should know?

Registration Price

Price: $ 150.00

Stripe Credit Card *

Card

Name on Card

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