Registration 2 — Civilian Man

Brothers — let's finalize your registration.

Step 1 of 3: Tell us about yourself.

Tell us about yourself

Your answers help us understand where you're coming from before our call together. When you're done, we'll take you to schedule your call with Mike.

Full Name

Phone Number

Please provide a brief overview of your current career field, title, job description, and how long you have been in this industry

Please provide a brief overview of what you feel has had a negative impact on your life beginning with childhood, relationships (marriage, family, friendships), and your current season as a man

How do you consider the condition of your heart to be at this present time? (e.g., angry, ashamed, addicted, isolated, numb, hopeless, etc.)

What other Christian-based or faith-based programs have you attempted in pursuit of healing for invisible wounds? Did they provide the relief or freedom you were looking for?

Are you currently involved in mental health counseling?

Yes

How much notice would you need in order to attend one of our 5-day programs? (e.g., 2 weeks, 1 month, etc.)

Hot Fill List: Sometimes a registered attendee cancels with little notice, opening a Drop Zone seat for someone who can attend on just a few days' notice. Would you like to be considered for our Hot Fill list?

Yes

Brothers — let's finalize your registration.

Step 1 of 3: Tell us about yourself.

Tell us about yourself

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