Select a Consultation Date:
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Retreat: Sunday 03/29/2020 10am-2pm EST (WAITLIST)
Wednesday 04/01/2020 12pm-2pm EST (Child-Focused)
Thursday 04/30/2020 10am-12pm EST
Thursday 05/21/2020 1pm-3pm EST
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Type of Consultation
*
Foundational Training (Institute for Creative Mindfulness)
Certification
Consultant-in-Training
Other
If other selected (or N/A):
Who did you complete your foundational training with?
Institute for Creative Mindfulness
Other
If other selected (or N/A)?
When did you complete your foundational training?
Attendance
*
In-person
Teleconference
I verify that I understand the group guidelines listed on the consultation website
*
Yes
No
I verify that I understand the cancellation policy
*
Yes
No
Pay Online
Credit Card/PayPal: $75
Credit Card/PayPal: $100
Credit Card/PayPal: $200
My Products
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EMDR Therapy Consultation: Foundational Training
$
75.00
EMDR Therapy Consultation: Certification (Private Practice)
$
100.00
EMDR Therapy Consultation: Certification (Non-profit)
$
75.00
EMDR Therapy Consultation: Consultant in Training (Private Practice)
$
100.00
EMDR Therapy Consultation: Consultant in Training (Non-profit)
$
75.00
EMDR Therapy Consultation Retreat
$
200.00
WAITLIST
$
Free
Total
$
0.00
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