Registration Application

Please follow the prompts on this Registration Application to tell us a little about yourself, upload required and supplemental documents, and select a payment option for your training.

If you have any questions along the way, send us a message and we will be happy to help!

Once the Registration Application and Participant Agreement are received, we will send you a confirmation email within 3 business days.

Registration Application

Name*
First Last
Degree*
Professional License*
License Number and Licensing State*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Office Phone*
Cell Phone (optional)
Email*
How did you learn about our training?*
Registration for: Fall 2020 Basic Training in EMDR Therapy, Online Live Webinar

Dates: September 19-20, October 17-18, November 14-15, December 12-13, 2020

Required Registration Documents -- please upload the following required documents:
- Current CV
- Copy of Professional License

Supplemental Registration Documents --

- Proof of prior EMDR Basic Training (Reviewers only)
- Pre-Licensed Verification Letter -- Applicant
- Pre-Licensed Verification Letter -- Clinical Supervisor
- Pre-Licensed Verification Letter -- Managing Supervisor
- Nonprofit Employment Verification Letter -- Employer
Upload Required & Supplemental Documents
Drop files here or

Accepted file types: pdf, png, jpeg, docx, docm, dotx, dotm, dotb.
PAYMENT OPTIONS -- please select one of the following payment options:
Early Registration
Standard Registration
Early Registration — Prior to August 1, 2020 — Licensed
- Installments: $1530 ($510 initial deposit, plus 2 future installments)
- Single Payment: $1500
Early Registration — Prior to August 1, 2020 — Nonprofit or Pre-licensed
- Installments: $1380 ($460 initial deposit, plus 2 future installments)
- Single Payment: $1350
Standard Registration - Licensed
- Installments: $1740 ($580 initial deposit, plus 2 future installments)
- Single Payment: $1700
Standard Registration — Nonprofit & Pre-licensed
- Installments: $1530 ($510 initial deposit, plus 2 future installments)
- Single Payment: $1500
Total
$0.00
Payment Terms*
I agree to the terms below.
PLEASE NOTE: Payment is to be made via PayPal; once you submit your application, you will be directed to that site. You do not need to have a PayPal account to pay for registration; once directed to the PayPal site, you have the option to use a credit or debit card.

REFUND POLICY: tuition is refundable upon written request up to 45 days before the first day of training, less a $50 administration fee. Within 45 days of the training, a refund will be made only if the vacancy can be filled from the waiting list, in which case, there will be a $150 administration fee. Once the training begins, we do not fill vacancies and no accommodations, refunds, or credits will be made for changes in personal, family, or business situations, including medical events. Should you need to withdraw after your acceptance, you may request a transfer for the next training cycle by submitting the “Transfer Request and Agreement” form. A transfer fee of $150 will apply, and your original tuition remains non refundable.

PAYMENT AGREEMENT: If you selected the ‘full payment’ option on this application, you agree to pay the full tuition amount in a single payment. If you selected the ‘installment payments’ option on this application, you agree to pay the tuition in three equal installments. The three equal installments will be charged as follows: 1) upon acceptance of application; 2) the week prior to the first training weekend; 3) the week prior to the third training weekend.