Heaven’s Gain Ministries APPL Registration Form

Please complete this form to participate in the Heaven’s Gain Ministries’ APPL (Advocates for Parents of Perinatal Loss) Training. In class training will be held at Heaven’s Gain Ministries, 6962 Harrison Avenue, Cincinnati, Ohio, 45247, on 2 consecutive weekdays from 9:00 a.m. to 4:00 p.m. with a break for lunch. Lunch will be provided by HGM.

Name *

First

Last

I will attend the 3-day training *

In Person
Via Zoom

Occupation (i.e. Nurse, Social Worker)

Email *

Cell Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Training Fee of $500 *

I will submit Credit Card payment below
I will submit payment by check
My Facility/Employer will submit payment

Credit Card Payment

Card

Name on Card

Do you have any food allergies or sensitivities? *

If "Yes", please describe:

This training may not be used to assist a women through an elected termination/abortion. *

Yes, I agree
No, I do not agree

Comments:

Our office will be closed on Tuesday, December 24, and Wednesday, December 25. Please keep in mind that any orders received on those days will be shipped on Thursday, December 26th.

Call Us: +1 (513) 607-6083
heavensgain.staff@gmail.com

Call Us: +1 (513) 888-4200

Heaven’s Gain Ministries APPL Registration Form