Course Registration Form
Healing Warrior Hearts
Fill out and submit this form to register for any course listed in "Course/Date" below.
For specific date details, see the calendar or click on More Info on a specific item below.

Course/Date*

Please register for only ONE retreat date!
We will contact you to confirm your registration.
If the date you choose is not available, we will discuss
optional dates with you after receiving your registration request.

  Course/Event Location Specifics Start Date Cost  
Healing Warrior Hearts Couples WeekendHouston, TXFebruary 2025February 28, 20250.00More Info opens in a new window
Healing Warrior Hearts MSTMilwaukee, WIMarch 2025March 21, 20250.00More Info opens in a new window
Healing Warrior HeartsHouston, TXMay 2025May 16, 20250.00More Info opens in a new window
Healing Warrior HeartsMilwaukee, WIJune 2025June 27, 20250.00More Info opens in a new window
Healing Warrior Hearts Couples WeekendMilwaukee, WIAugust 2025August 8, 20250.00More Info opens in a new window
Healing Warrior Hearts MSTMilwaukee, WISeptember 2025September 19, 20250.00More Info opens in a new window
Healing Warrior HeartsHouston, TXOctober 2025October 3, 20250.00More Info opens in a new window
Healing Warrior Hearts LGBTMilwaukee, WIOctober 2025October 24, 20250.00More Info opens in a new window
Will you be a participant or staff member?* if staff, are you a veteran or civilian?
First Name*
Last Name*
Email
Occupation
Birth Date  (format m/d/yyyy)
Street Address
City
State
Zip
Home Phone**  (format 123-456-7890)
Cell Phone**  (format 123-456-7890)
Work Phone**  (format 123-456-7890)
Who referred you to us?
If registering as a Participant, please give us information about your service and goals
Branch
MOS
Have you served in Combat?   if yes, theater of action:
Dates of service
What is the outcome you would
like for yourself from attending
this program?
Other comments

Are you a human?*

(This helps us prevent
spam and bots)

*Required
**At least one telephone number is requiredz

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