I would like to register for:
Rachel’s Vineyard Spring Retreat, April 2024
Rachel’s Vineyard Fall Retreat, October 2024
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Signature
How long ago did you experience your abortion(s)?
What symptoms of post-abortion trauma have you struggled with (past or present)? (check all that apply)
Anger
Remorse, regret
Guilt, shame
Sorrow, heartache
Troubling dreams, flashbacks
Depression
Anxiety, panic attacks
Emotional numbing
Low self-esteem
Addictions
Thoughts of suicide
Other
What would you say is the worst thing for you right now?
Submit
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