Get Updates About New EMDR Training Offerings

Online Registration for the Basic EMDR Training Seminars

Please fill in and submit the form below with your registration information.
Once you have submitted the form, you will be directed to the payment page. Thank You.

Date of Seminar*	MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2010 2011 2012 2013
Name of Participant* (First Last)
Degree*
How you would like your name to appear on your Certificate of Completion?
Certificate Name*
Professional License and Number* OR
Supervisor Name, License & Number
Address*
City*
State*
Zip Code*
Business Phone*
Home Phone*
Email*
Confirm Email*
Payment Method*	Credit Card Check
Name of Person/Agency paying for the Training* (MUST Match Payment Page)
NBCC Credits?*	Yes No
How did you hear of us?
* Denotes required fields. If you are a student/intern, please send us a letter verifying your status from your supervisor with his/her degree and license number. All costs must be paid in U.S. funds.