Families in Crisis Conference

Conference Date*

Number of Attendees

First Guest*

First Name

Last Name

Second Guest

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Primary Phone*

Email*

Child's Gender*

For coordination purposes please let us know the gender and age of the child you are struggling with.

Child's Age*

Briefly describe the issues you are facing with your child or children.*

How did you hear about the Families in Crisis Conference?*

Are you interested in bundling your registration with our Crisis Coaching program at a discounted rate?

No, I'm not interested Yes, I want to add individual crisis coaching - (x4 sessions, 1 hour each)

Are you interested in bundling your registration with our Crisis Coaching program at a discounted rate?

No, I'm not interested Yes, I want to add on Crisis Coaching for my family

Seminar Price

Discount Code

Total Price $

Discounted Price $

Credit Card*

Plese Confirm:*

I understand that this is an in person conference that takes place on the Heartlight Ministries Campus in Longview, Texas.

Comments

IN-PERSON CONFERENCE REGISTRATION