Basic Contact Information

First Name*

Last Name*

Email Address*

Phone Number

Preferred Contact Method* (Click the Dropdown)
EmailPhoneEither

Church / Organization Details

Church or Organization Name*

City

State / Province

Zip Code

Role or Title* (Pastor, Director, Staff, etc.)

Denomination or Affiliation

Service Interest

Which services are you interested in?*

On-Call ConsultationLeadership TrainingCounseling Ministry PlanningChurch Mental Health Training (workshops, seminars, retreats)Live Event / Conference SpeakingCustom Training or Consultation

Preferred Format* (Click the Dropdown)
In-personVirtualHybrid / Either

Primary Audience (you can select more than one)

Pastors and clergyChurch staffLay leaders / volunteersCongregation-wideNonprofit or community partners

Estimated Group Size (Click the Dropdown)
Under 2525–5051–100100+

Preferred Date or Date Range

How many hours of training are you considering? (Click the Dropdown)
90-minute sessionHalf-day (3 hours)Full-day (5–6 hours)Multi-session seriesNot sure, please recommend

Briefly describe what you are hoping this training or consultation will address.*

Budget and Decision Timeline

Budget Range (optional) (Click the Dropdown)
Not sure yetUnder $1,000$1,000–$3,000$3,000–$5,000Over $5,000

Decision Timeline* (Click the Dropdown)
Within 2 weeksWithin 1–2 monthsLonger than 2 monthsJust exploring options

How did you hear about Church Mental Health Training?

I am open to receiving occasional updates about trainings and resources.

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