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)
Professional License (required)
State in Which License Issued (required)
License Number (required)
Training for which you are registering:
Dallas 2017/2018Houston 2018Austin Spring 2018
How would you like to pay?
Online PaymentPayment PlanPay by Check
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.