EMDR Online Registration

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To Register Online:

  1. Download the PDF form
  2. Fill out and Save completed form
  3. Submit using the upload form below
  4. Complete payment via PayPal using the Payment section below
  5. You will be sent confirmation once your registration has been processed

Download Form:

Download form to your computer then open in Adobe Reader to fill out. Once completed, save form PDF and upload using the upload form below.

Download Registration Form PDF

Submit PDF:

Submit EMDR Registration

  • Name*full name

    0

  • Email*a valid email address

    1

  • Upload Completed Form PDF*upload PDF hereUpload

      2

    • Captchacopy the words

      3

    • 4

    Select Payment:

    EMDR: Session one & two

    Amount:

    $2,000

    EMDR: Session one & two - DEPOSIT ONLY

    Amount:

    $600

    NON-REFUNDABLE