GTF Workshop Registration

This registration is for the workshop on:

Name

Preferred Name (i.e. Bob, John, Bill)

This address will receive a confirmation email

Mobile Phone

Address

Marital Status

We are asking for your wife's name and email for the Gateway to Freedom wives informational meeting. Please let her know to expect our email the week before the workshop.

Wife's Name and Email

Age

Do you have any dietary restrictions?

If Yes, what are they?

Eligibility Requirements

Answering the following questions helps us better serve you at the workshop. All answers are confidential.

Primary Struggle (pick up to 3)

Porn Fantasy Masturbation Internet Live Encounters Unwanted Same-Sex Attractions Other

Eligibility Verification (check all that apply)

I struggle with sexual strongholds in thoughts/behaviors I am over 21 years old I desire help for my sexual brokenness

Survey (check all that apply)

I have engaged in sexual behaviors I wish I could stop. I feel abnormally driven by my sexual drive. I have been in a relationship just for sex. Masturbation has been ongoing even after marriage. I have continued to use pornography after entering a long-term, committed relationship. My sexuality seems to be dragging down my personal potential. I spend a significant amount of time viewing porn or grooming others for sexual encounters. I have experienced unwanted sexual encounters during childhood or adolescence. Monogamous sex has grown to be boring.

Attendance Requirements

I understand GTF is a Christian, Bible-based workshop. I understand and agree to shared lodging while attending the workshop.

Roommate Request (if attending with someone.)

If Other, please share where:

Workshop Payment

Choose Your Payment Option

*For Schlolarship Submissions: you must have payment arrangements for the remaining balance made prior to attending the workshop.

The fee for the workshop covers food, lodging, workshop materials, and the group counseling sessions. If you select the 4-month Pay Plan option below, you will receive instructions for how to set up your pay plan when you click the Submit button.

IMPORTANT: Your registration is not complete until you submit this Application and either Pay in Full or have your Pay Plan set up.

If you have questions about your registration or setting up your pay plan, please call us at 1-800-497-8748, ext 106.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

GTF Workshop Registration

Description

Please Fix the Following