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Life Affirming Specialist Application
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Become a Life Affirming Specilalist
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Life Affirming Specialist (LAS)
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$ 99.00
Total Amount
Name and Address
First Name
*
Last Name
*
First and last name will be shared with other visitors to the site.
Pregnancy Help Organization you are associated with:
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Which of the following best describes your role/position within the organization above (check all that apply).
Role:
Board Member
CEO/President
Director
Executive Director
Founder
Media
Medical Director
Nurse
Political
Staff – Paid
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Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
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Cayman Islands
Central African Republic
Chad
Chile
China
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Cocos (Keeling) Islands
Colombia
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Congo, The Democratic Republic of the
Cook Islands
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Guinea-Bissau
Guyana
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Heard Island and McDonald Islands
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Hungary
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Indonesia
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Iraq
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Isle of Man
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Jordan
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Nigeria
Niue
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Panama
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Pitcairn
Poland
Portugal
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Qatar
Reunion
Romania
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Rwanda
Saint Barthélemy
Saint Helena
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Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
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Samoa
San Marino
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Senegal
Serbia
Serbia and Montenegro
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Sierra Leone
Singapore
Sint Maarten (Dutch Part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
State
*
Choose country first
Postal Code
Email
*
I am accessing this resource in connection with my role within a life affirming (pro-life) Pregnancy Help Organization. I understand that this resource is intended for a pro-life audience and is considered off the record. Additionally, I understand that my registration may be subject to cancellation (with a full refund of any fees paid) by Heartbeat International at any time and for any reason. I understand that all media inquiries should be directed to: media@heartbeatinternational.org
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Feb
Mar
Apr
May
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-year-
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2026
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2033
2034
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Billing Name and Address
Billing First Name
*
Billing Middle Name
Billing Last Name
*
Street Address
*
City
*
Country
*
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic Of The
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch Part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
State/Province
*
Choose country first
Postal Code
*
Life Affirming Specialist Details
Two years experience in Life Affirming Ministry
Yes
No
LOVE Approach Training Requirement
LOVE Approach Online
LOVE Approach Training at my center by Heartbeat Staff or Consultant
LOVE Approach Training led by my center
Other volunteer training
Reference
Please explain in detail how you have met the 14 hour training requirement for the last two years.
Continuing Education Requirement
*
Clients are served without regard to age, race, income, nationality, religious affiliation, disability or other arbitrary circumstances. Clients are treated with kindness, compassion and in a caring manner. Clients always receive honest and open answers. Client pregnancy tests are distributed and administered in accordance with all applicable laws. Client information is held in strict and absolute confidence. Releases and permissions are obtained appropriately. Client information is only disclosed as required by law and when necessary to protect the client or others against imminent harm. Clients receive accurate information about pregnancy, fetal development, lifestyle issues, and related concerns. We do not offer, recommend or refer for abortions or abortifacients, but are committed to offering accurate information about abortion procedures and risks. All of our advertising and communication are truthful and honest and accurately describe the services we offer. We provide a safe environment by screening all volunteers and staff interacting with clients. We are governed by a board of directors and operate in accordance with our articles of incorporation, by-laws, and stated purpose and mission. We comply with applicable legal and regulatory requirements regarding employment, fundraising, financial management, taxation, and public disclosure, including the filing of all applicable government reports in a timely manner. Medical services are provided in accordance with all applicable laws, and in accordance with pertinent medical standards, under the supervision and direction of a licensed physician. All of our staff, board members, and volunteers receive appropriate training to uphold these standards.
Please date and initial indicating your agreement to the Commitment of Care and Competence (above)
*
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