Registration Form: EMDR Therapy Refresher Part II

With Elizabeth Legg, PhD, LPC, NCC

The Road Less Traveled Counseling Center, PLLC

Date of Part II Refresher Training *

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone *

Email Address *

How did you hear about us? *

EMDR Therapy Refresher Part II is available to licensed mental health professionals who have completed an EMDRIA-Approved EMDR Basic Training. Please provide the following information regarding your licensure situation and EMDR Basic Training.

Type of License *

License Number *

Issuing State/Province/Region *

Please provide your EMDRIA-Approved EMDR Basic Training Trainer’s Name *

Please provide the date you completed the EMDRIA-Approved EMDR Basic Training * +

Fees: $175 total due at time of registration

Cancellation policy: Refund of $125 up to 14 days before live Part II training. No refund within 14 days of training. If for any reason you need to delay and take a later Part II session, there will be a $50 administration fee. Notification must be made at least 14 days prior to the live Part II training.

Fees: $175 total due at time of registration

GRIEVANCE POLICY:

The Road Less Traveled Counseling Center and Elizabeth Legg are fully committed to conducting all activities in strict conformation with the Association of Social Work Boards (ASWB), the American Psychological Association (APA), American Counseling Association (ACA), National Board for Certified Counselors (NBCC), and EMDR International Association (EMDRIA) grievance procedures as well as with all legal and ethical responsibilities of those organizations. We are committed to transparent, respectful, fair, and non-discriminatory promotional activities, program content and in the treatment of program participants. The monitoring and assessment of compliance with these standards will be the responsibility of the The Road Less Traveled Counseling Center.

While The Road Less Traveled Counseling Center goes to great lengths to assure fair treatment for all participants and attempts to anticipate areas of concern, there will be occasional issues which come to our attention, requiring intervention and/or action on the part of The Road Less Traveled Counseling Center. During a training, should a concern arise for any participant, Elizabeth Legg, The Road Less Traveled Counseling Center, and our advisory committee are invested in addressing those concerns in a timely, thoughtful and respectful manner, to include changing practice partners, addressing staff or facility issues, improving course content, etc. All grievances (including complaints about course content, speakers, facilities, and nonreceipt of certificates, as well as refund requests and other miscellaneous occurrences) are reviewed and addressed by our advisory committee, which is made up of Psychologists, Licensed Professional Counselors, Licensed Clinical Social Workers and the ACE Social Work Consultant.

Our advisory committee can be found HERE in the Training Team section of the page. Our committee will make every effort possible to include the most appropriate member(s) of the advisory committee in the response to any grievance in such a way as to lessen the risk of bias and involvement in multiple roles, while increasing the opportunities for problem resolution, strengthen decisions regarding such complaints, and to maximize objectivity. The Road Less Traveled Counseling Center’s approach to resolving grievances is always from the perspective of what is in the best interest of the participant.

All complaints and grievances are reviewed within 5 working days. Formal grievances are required to be written and emailed to grievance@theroadlesstraveledcounseling.com and will be responded to within 10 business days. If The Road Less Traveled Counseling Center is am unable to resolve your complaint to your satisfaction, you have the right to file a grievance with the Mental Health Licensing Section of the Colorado Department of Regulatory Agencies (DORA): 1560 Broadway Street, Suite 1350, Denver, CO 80202; 303-894-7800.

Acknowledgments: *

I understand that I committing to watch the entire Part I On Demand portion of the EMDR Therapy Refresher training prior to the Part II training date

I understand that I need to have previously completed an EMDRIA-Approved EMDR Basic Training

Caution: For participants with untreated trauma histories, there is a possibility that this training may tap into unconsciously held (and previously unknown), highly charged trauma material

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Date: * +

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Total fee due at registration ($175)

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