EMDR Therapy and Addictions Workshop Registration
Presented by Hope Payson LCSW, LADC & Kate Becker LCSW, RYT
April 20-21, 2018 8:30AM - 4:30PM
Crown Plaza Milwaukee Airport Hotel
6401 S. 13th Street, Milwaukee, WI 53221
Email address *
Contact Information
First and Last Name with Licensure: (as you want it listed on your Name tag and Certificate of Attendance) *
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License Number & State: *
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Mailing Address: *
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Mailing Address 2
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City: *
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State: *
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Zip: *
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Telephone: *
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Tuition
Postmarked after 3/20/18............$375
Cancellation/Refunds: No refunds after 4/6/18.
Discounts Available
Eligible for A Discount? (Choose only 1)
Payment Options:
There are several options to pay for the workshop. If necessary, use the Notes Section to provide additional information. Please Note: Read the instructions carefully when using one the Credit Card options. You need to submit this Registration Form as well as COPY the appropriate secure link so you can PASTE it into your browser to make the payment.

1. Venmo App User: Submit this form to register for the workshop and then pay with the Venmo App using my username of Wendy-Freitag

2. Check: Submit this form to register for the workshop and then send check to address below.

3. Credit Card: Submit this form to register and use the appropriate secure link to make the credit card payment.

4. If you are applying for a discount when 3 or more people register together, please contact Wendy J. Freitag Ph.D. at wendy@emdrtherapywi.com for a specialized Registration Form.

I will pay using: (Check one and following the instructions to submit the payment) *
Required
Confirmation of Registration
A confirmation email including important workshop and facility information will be sent within one week of your registration and payment. If you do not receive the email, please email Wendy at Wendy@emdrtherapywi.com. Thank you.
Notes:
Have a question or comment?
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Payable to: Wendy J. Freitag, Ph.D.
1200 N. Mayfair Road, Suite 390; Wauwatosa, WI 53226
Email: wendy@emdrtherapywi.com
Tel: (414) 777-1757 Fax: (414) 777-0160

Please pass along the workshop information to your EMDR Therapy colleagues. Thank you.
I look forward to seeing you in April!

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