Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Does your phone receive texts
*
Yes
No
Will you be attending the Spiritual Guidance session on Friday evening
*
Yes
No
Do you want CEU's for your participation in these sessions?
*
Yes, Workshops (CEU is 0.8)
Yes, Spiritual Guidance (CEU is 0.1)
No
What nights do you need lodging"
*
Thursday
Friday
None
Double occupancy
What meals will you need
*
Thursday dinner
Friday breakfast
Friday lunch
Friday dinner
Saturday breakfast
Saturday lunch
None
What, if any dietary restrictions do you have?
What is your approximate arrival time at Heartland?
What is your approximate departure time from Heartland?
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