First Name (required)

Last Name (required)

Nickname (name as you would prefer it on your nametag)

Agency or Company Name

Work Phone (required)

Alternate Phone (required)

Email Address (required)

Street Address(required)

City (required)

State (required)

Zip (required)

Degree (required)

Professional License (required)

State in Which License Issued (required)

License Number (required)

Please upload proof of full time employment at the non-profit or government agency you work for. Pay stub showing hours worked is required. You may also email these documents to niki@ricklevinson.com or fax them to 512-327-4944.

Training for which you are registering: Please Note: All Trainings are being taught virtually at this time.
Virtual Training April/July 2022 (This Training is in progress)Virtual Training June/October 2022 (This Training is in progress)Virtual Training August/December 2022 (A Wait List has been started for this Training)Future Trainings

How would you like to pay?
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I understand the following requirements of the EMDR Therapy Training:
• To participate in all portions of the training, including all segments of both weekends.
• To practice the skills learned in the weekends and begin to actively use EMDR.
• To bring the worksheets of that work to consultation for review and support.

I further understand that I may not participate in consultation sessions without having work to present and that the completion of the consultation sessions is required to complete this EMDR Therapy Training.

I Accept

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