EMDRIA Approved EMDR Basic Training Registration and Payment

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

License Type (eg. LPC, LPC Associate, Student, LCSW)*

Select Training Session*

Choose Your Payment Option*

Student / Nonprofit Registration – Paid in Full

For graduate students or clinicians working in nonprofit community mental health settings. Includes: • 6 live virtual training days • 20 hours practicum • 10 hours group consultation • Printed training manual mailed to you Verification may be requested.

$1,250.00

Student / Nonprofit – Payment Plan (3 Monthly Installments)

First payment due at registration. Remaining payments automatically drafted monthly. Payment plan must be completed before Weekend 2 begins.

$420.00

Professional Registration – Paid in Full

For licensed professionals in private practice, group practice, hospital, school, or agency settings. Includes: • 6 live virtual training days • 20 hours practicum • 10 hours group consultation • Printed training manual mailed to you Payment due at registration.

$1,425.00

Professional Registration – (3 Monthly Installments)

Pay the training fee in 3 equal monthly installments. First installment due at registration. Payment plan must be completed before Weekend 2 begins.

$475.00

Total

$0.00

I understand that this training requires full participation, attendance, and completion of all components. I acknowledge that payment secures my seat and that training materials are provided digitally. I agree to the terms and expectations outlined for this training.I understand that I must have access to a Google account to participate in this training.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.