Clone of JUNE 11-13 Phase 1 Registration

Phase One Registration. (AUGUST 6-8, 2026)

Space is limited * Payment plan available
Meeting online (THU-FRI-SAT) from 10:00 - 6:30 Central

21 approved CE hours. Diverse, inclusive training experience. Come learn-heal-expand with us!
Your name (as you want it to appear on certificate)*

First NameLast Name
Preferred name (if different)
Best Email*
example@example.com
Mobile Number*
Please enter a valid phone number.Format: (000) 000-0000.
Nature of your work/Title:*
(Counselor, LMFT, Health Coach, etc.)
Birth Date

MonthDayYear
Your Mailing Address*

Street Address

Street Address Line 2

CityState/Province

Zip CodeCountry
Brainspotting.comOnline SearchFriend/ColleagueJoy the trainerOther
Who can we thank for the referral?
YESNO
-------------------------------------------------------------------------------------------

Phase 1 and 2 Certification Bundle (Option)

If you know you want to get certified in Brainspotting, consider adding the Phase 2 training at the super early bird $745 rate.
- Choose OCT 1-3 or NOV 19-21 at the bottom or this form
- Receive HANA member benefits for consult groups and classes in 2026
- Transfers/Refunds are possible until 3 weeks before the event
- Email us at brainbodyrevolution@gmail.com if you have questions
- You can sign up for Phase 1 today and add Phase 2 at a later date
-------------------------------------------------------------------------------------------
OCT 1-3NOV 19-21
If registering at reduced rate, please list your supervisor's name and/or school to indicate you are pre-licensed or an active grad student below:

TUITION: Select and scroll down to pay*

Brainspotting Phase 1

Super early bird good thru June 24th

$745

Add Phase 2 (option)

Reserve now to save. Select preferred dates on the bottom.

$745

Grad Student - BSP Phase 1

Non-working interns. Documentation required.

$400

Grad Student - BSP Phase 2 (optional)

For Non-working interns.

$400

Deposit - BSP Phase 1

then pay $375 until June 1

$375

Final payment - BSP Phase 1

Pay $425 after June 24

$375

Enter coupon

Total

$0.00

Should be Empty:

Phase One Registration. (AUGUST 6-8, 2026)

Meeting online (THU-FRI-SAT) from 10:00 - 6:30 Central