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

Layout

I will attend the 2-day training *

In Person
Via Zoom

What is your availability for the 2-day training?

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:

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

Call Us: +1 (513) 888-4200

Heaven’s Gain Ministries APPL Registration Form