Professional Training Registration


Please complete this online registration form. Within the next 48 hours, you will receive communication from Kathleen Martin or Deb Perkowski, organization assistant, regarding the payment process.
Which workshop are you registering for?
Last Name:
First Name:
Middle:
Street:
City:
State:
ZIP Code:
E-Mail Address:
Phone Number:
Cell Phone:
Mental Health Professional License Number:
Are you trained in EMDR therapy?
When were you trained in EMDR therapy?
Who was your trainer?