Registration Form: EMDR Therapy Refresher Part I - On Demand

With Elizabeth Legg, PhD, LPC, NCC

The Road Less Traveled Counseling Center, PLLC

First Name *

Last Name *

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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 * +

Acknowledgments: *

I understand that I am committing to watch the entire Part I On Demand portion of the EMDR Therapy Refresher.

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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