EMDR Basic Training Registration
Registration for EMDR Basic Training
Email address *
Which EMDR Training are you signing up for? *
Full name *
Your answer
Address (street) *
Your answer
Address (street 2)
Your answer
City, State and Zip *
Your answer
Phone number *
Your answer
Professional License *
Your answer
Licensure State
Your answer
License Number
Your answer
Are you a student/intern? *
If you are a student, please submit a letter from your supervising professor permitting you to participate in this training. Please ensure your professor reads the Participation Agreement. I understand this.
I understand that the EMDR Basic Training Fee is non-refundable, however may be applied to different training dates in the event that an unforeseeable circumstance arises and I am unable to attend the training. I also understand that I am responsible to read, understand and agree to the EMDR Basic Training Participation Agreement before submitting this registration form. *
How will you be paying? *
A copy of your responses will be emailed to the address you provided.
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