Group Leader Application

Term: One-time $79 registration fee, then $5/month.

Terms:

1 Month for $79 then $5 / Month

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Phone Number:* Phone Number is Required

Are you part of a HealingStrong Group?: Are you part of a HealingStrong Group? is not valid

If so, which one?: If so, which one? is not valid

I affirm and agree to uphold the Core Values of HealingStrong as long as I am conducting Healingstrong Meetings or representing HealingStrong in any way.*

I understand that all HealingStrong Group Leaders must also complete the HealingStrong application to gain access to online training materials, training, and benefits. Co-leaders must also be a registered HealingStrong Group Leader.*

Birthdate:* Birthdate is Required

Please tell us a little about yourself, why you are interested in leading a HealingStrong Group, along with your personal journey to healing strong and staying strong.:* Please tell us a little about yourself, why you are interested in leading a HealingStrong Group, along with your personal journey to healing strong and staying strong. is Required

What best describes your experience with holistic strategies to heal and stay strong?:* What best describes your experience with holistic strategies to heal and stay strong? is Required

Please upload a photo of yourself (optional): Please upload a photo of yourself (optional) is not valid

Please tell us what resource led you here? Check all that apply: Please tell us what resource led you here? Check all that apply is not valid

Referral or other resource: Referral or other resource is not valid

Referral Name 1:* Referral Name 1 is Required

Referral Email 1:* Referral Email 1 is Required

Referral Phone 1:* Referral Phone 1 is Required

Referral Name 2:* Referral Name 2 is Required

Referral Email 2:* Referral Email 2 is Required

Referral Phone 2:* Referral Phone 2 is Required

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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