Workshop Registration

 
Which workshop are you registering for?
Last Name:
First Name:
Middle:
Street:
City:
State:
ZIP Code:
E-Mail Address:
Phone Number:
Cell Phone Number:
License Number:
Year you completed your basic EMDR training:
Who was your trainer?
How many EMDR sessions do you do per week?
What is your client population?
Do you understand that you will be participating in a practicum during part of this workshop?
What do you hope to learn from this workshop?