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Pastoral Counseling Specialist Training -Registration
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Last Name *
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Birthdate *
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Address *
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Address
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City *
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Zip Code *
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Email Address *
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Preferred phone number *
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Fee *
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** Mailing Address for Check: Aaron Pawelek, 15 Ermer Road, Suite 215, Salem, NH 03079
For which session would you like to register? *
Pastoral Work History
(Please provide date, locations and descriptions of your last three positions)
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Educational Credentials since High School
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What goals are you pursuing in the Pastoral Care Specialist Program?
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What goals are you pursuing in the Pastoral Care Specialist Program?
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By Completing this form, you grant the AAPC Training Program permission for a formal background check. *
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