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Embodied Legacies – Somatic Approaches to Transgenerational Healing 
Thank you for your interest in the program. Please fill the application below. Upon revision, you will receive an email with further instructions. With gratitude.

Registration Fee: after submitting the form, you will be redirected to a payment link to pay the deposit for the training ($100).

Disclaimer on CE: 

  • This training includes both licensed mental health professionals and non-clinical participants. 
  • The training is intended to meet continuing education (CE) requirements for licensed mental health professionals.
  • Please review the CE Policies to decide what applies to you
  • Participants are responsible for determining applicability to their individual licensure or certification requirements and for practicing within their professional scope.
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