Select a Consultation Date:
*
Wednesday 4/14/2021 1pm-2pm EST (WAITLIST ONLY)
Wednesday 4/28/2021 6pm-8pm EST
Saturday 5/1/2021 10am-12pm EST (Child-focused)
Wednesday 5/5/2021 12pm-1pm EST
Consultation bundle (trainee/agency clinician) 5 groups $318.75
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
*
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: $40
Credit Card/PayPal: $75
Credit Card/PayPal: $100
Credit Card/PayPal: $200
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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: Lunchtime 1 hour Group
$
40.00
EMDR Therapy Consultation Retreat
$
200.00
WAITLIST
$
Free
EMDR Consultation Bundle (Trainee/Agency): 5 prepaid groups
$
318.75
Total
$
0.00
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