EMDR Waitlist Registration

Select a training:

Name

First NameLast Name

E-mail

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Profession

If other profession selected (or N/A):

License Number

Licensure State

If I am a graduate student or part of a profession that falls outside the scope of general eligibility for this training, I understand that my acceptance to the training is contingent on approval

Supporting documentation for special cases

Upload a File

I verify that I have read all of the information on this website about the training process, including the frequently asked questions

I verify that I understand the cancellation policy

I understand that attendance at the entire training is required. I also verify my understanding that taking an extensive training in a form of trauma therapy like EMDR Therapy can be an intense experience and that I am aware of the potential risk. I fielded any concerns about my ability to take the training through Suzi Rutti or a member of the Institute for Creative Mindfulness Team before registering

Do you require any disability accommodations? (please specify)

Payment type