On-Site Consultation Registration

Please complete this registration only once a date has been selected and approved. Please note, the dates appearing in your confirmation reflect the pricing period. Your training dates have already been confirmed.

Please use this form to complete your consultation request and reserve your consultation date. Please refer to your letter for information regarding the date(s) of your training.

Consultation Request

Please specify if this consult is taking place virtually or in-person.

Consultation Type: *

Onsite (Location Details Provided Below)

Virtual

Please provide the confirmed date and time of your consult. If you are doing a virtual consult, please provide the date of the first session.

Confirmed Date and Time: *

Please provide the location where the training/consultation will be held. For virtual consults, please provide the center address.

Consultation Location: *

Organization Name *

Street Address (Work) *

City (Work) *

Country (Work)

State (Work) *

Postal Code (Work)

Organization Phone *

Organization Email

Your Email

First Name

Last Name *

Job Title *

Fee

If you have a discount code, enter it here

Please select the training(s) and/or consultation(s) you have requested: *

Governing Essentials Board Training - $ 1,200.00

The LOVE Approach Training - $ 1,200.00

Talking About Abortion Training - $ 1,200.00

Abortion Recovery Training - $ 1,200.00

Sexual Integrity Training - $ 1,200.00

Strategic Planning (1 1/2 days) - $ 1,700.00

Trauma Informed Care - $ 1,200.00

Maternity Essentials: Two Day Training - $ 2,000.00

Half Day Training - $ 500.00: (For Heartbeat Affiliates Only.)

Unless otherwise noted, price is for one-day on-site training.

Total

Credit Card

If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page.

Checkout securely. Pay without sharing your financial information.

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

If for any reason your center decides to cancel and is not able to proceed with the consultation on the agreed dates, your center will be permitted to reschedule (as consultants or independent contractors are available), within 2 years from the time of cancellation. Heartbeat works diligently to keep expenses low, our consultation pricing does not include margin to cover postponements and cancellations. Therefore, the cost of all travel expenses incurred by Heartbeat Intl. or the independent contractor in the process of planning this consult, including any fees or penalties incurred from cancellation, will be your responsibility in the event that you postpone or cancel.Furthermore, please be aware that neither HBI nor the independent contractors can be responsible for incurred travel expenses which are increased due to weather related and/or cancelled flights on the way to or from a training or consultation.