Oct 2024.EMDRTeens

EMDR with Resistant Teens and their Caregivers

October 9th, 10th & 11th, 2024
Name & Credentials

(Please write your name as you'd like it to appear on your certificate.)
First Name*
Last Name*
License Type (LMSW, LMHC, etc) Necessary for CE certificates*
What year did you complete EMDR Basic training? Prior EMDR training required for this course.*
Who was your trainer for basic EMDR?*
Agency Name*
Contact Info
Address: (Please use home address, as book and binder will be mailed to that address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail (please provide your personal email to prevent agencies from blocking us contacting you)*
example@example.com
Phone*
(no dashes or spaces)
Cancellation Policy:

No refunds after the starts of the program. There will be a $75 fee for those canceling 7 days or fewer day prior to the start of the workshop.
Policies

- If I used an agency email I may miss handouts and confirmations.

- I have read the cancellation policy above and understand that any cancellation of 7 days prior to the start of the workshop is a $75 cancellation fee. NO exceptions can be made to this policy.

- I understand that this is a LIVE online CONTACT training and that I will need to be on camera and participating in all experiential activities in order to receive CE's.

- Please read the brochure carefully for CE information for your state and discipline.
I acknowledge these policies*

yes
Payment

Choose your payment method
I will pay by

PayPal/Credit CardCheck

Cancellation Policy:

No refunds after the starts of the program. There will be a $75 fee for those cancelling 7 days or fewer day prior to the start of the workshop.
EMDR with Resistant Teens and their Caregivers: $300

Please make check payable to

Nicole Wolasz
Phoenix Therapy and Wellness
337 Cleveland Drive, Suite 6
Cheektowaga, NY 14215
Please mail immediately - must be received within 14 days of registration.

Cancellation Policy:

No refunds after the starts of the program. There will be a $75 fee for those canceling 7 days or fewer day prior to the start of the workshop.
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EMDR with Resistant Teens and their Caregivers

Name & Credentials

Contact Info

Payment