Secure Online Application for EMDR Training




EMDR Fall 2012 Basic Training Course Application

Thank you for your interest in the upcoming EMDR Basic Training.

In an effort to create the best possible environment for learning, applications must first be approved by the Program Director before enrollment.

Once an application is submitted, please allow 5 business days for review. When your application is approved, you will be sent full details of the program, including a path to a payment gateway allowing you to complete online enrollment. After approval, payment is due within 14 days. All payments must be received prior to the first day of training.

Thank you again for your interest and reach out to us by Email with any questions.

Please enter your Full Name:

What is your Profession?

How many years have you been practicing?

Please enter your License #

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Please enter your email address:

Phone Number (include area code):

As a participant, it is required that you share a minor personal issue of your own during the afternoon practicum.

By checking this box, you agree to share a personal issue with your small group of 2-3 people that you will work on as a client.

In order to participate, it is required that you have an established clientele with which you intend to practice EMDR.

By checking this box, you hereby certify that you have a client population to use EMDR with.

How did you hear about the training?

Please list any special accommodations that you may require for participation in the training.

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