Registration Form: EMDR Therapy Refresher Part II - Virtual

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 *

EMDR Therapy Refresher 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

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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