Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Church/Ministry Name *

First Name

Last Name

Would you like your staff/members to be trained to facilitate trauma healing groups? *

Yes

No

Would you like to host a trauma healing group led by CCM for your staff/members? *

Yes

No

What type of training is your organization interested in? Check all that apply: *

Adult

Children

Teen

Generational Healing