Scroll down the page to the registration form.
 

 

 

** Intern/Graduate Students:
Submit with registration a current supervisor's letter with his/her degree and license number.
Letter can be mailed or faxed to 831-761-1204

** Full-time Nonprofit (Community Mental Health) Employees:
Submit with registration on agency letterhead verifying full-time employment.
Letter can be mailed or faxed to 831-761-1204

ONLY ONE DISCOUNT PER REGISTRATION

Scroll Down the Page to the Registration Form and Fees.
 

Secure Registration Form

 
MUST SELECT
Date/Location:
Training Dates 2009 - Weekend 1 Training Dates 2009-2010 - Weekend 2
  Jun 12-14 2009 Denver CO-Weekend 2
Jan 23-25 2009 San Francisco CA-Weekend 1 Jul 17-19 2009 San Francisco CA-Weekend 2
Jan 23-25 2009 Tampa FL-Weekend 1 Jul 31-Aug 2 2009 Tampa FL-Weekend 2
Jan 23-25 2009 Arlington Heights IL-Weekend 1 Jun 12-14 2009 Arlington Heights IL-Weekend 2
Jan 30-Feb 1 2009 Waltham MA-Weekend 1 Jun 26-28 2009 Waltham MA-Weekend 2
Feb 6-8 2009 Seattle WA-Weekend 1 Jun 26-28 2009 Seattle WA-Weekend 2
Feb 6-8 2009 Overland Park KS-Weekend 1 Jul 24-26 2009 Overland Park KS-Weekend 2
Feb 27-Mar 1 2009 Albuquerque NM-Weekend 1 Jul 17-19 2009 Albuquerque NM-Weekend 2
Mar 6-8 2009 Charlotte NC-Weekend 1 Aug 7-9 2009 Charlotte NC-Weekend 2
Mar 6-8 2009 Irvine CA-Weekend 1 Jul 31-Aug 2 2009 Irvine CA-Weekend 2
Mar 6-8 2009 Bloomington MN-Weekend 1 Aug 7-9 2009 Bloomington MN-Weekend 2
Apr 3-5 2009 Portland ME-Weekend 1 Oct 9-11 2009 Portland ME-Weekend 2
Apr 17-19 2009 Cincinnati OH-Weekend 1 Oct 23-25 2009 Cincinnati OH-Weekend 2
May 1-3 2009 Philadelphia PA-Weekend 1 Oct 2-4 2009 Philadelphia PA-Weekend 2
May 15-17 2009 Salt Lake City UT-Weekend 1 Oct 16-18 2009 Salt Lake City UT-Weekend 2
Jun 5-7 2009 San Diego CA-Weekend 1 Nov 13-15 2009 San Diego CA-Weekend 2
Jun 12-14 2009 Atlanta GA-Weekend 1 Oct 16-18 2009 Atlanta GA-Weekend 2
Jul 17-19 2009 Denver CO-Weekend 1 Nov 20-22 2009 Denver CO-Weekend 2
Jul 24-26 2009 South San Francisco CA-Weekend 1 Nov 6-8 2009 South San Francisco CA-Weekend 2
Jul 24-26 2009 RTP NC-Weekend 1 Nov 6-8 2009 RTP NC-Weekend 2
 
2010 Dates
Aug 7-9 2009 Memphis TN-Weekend 1 Feb 26-28 2010 Memphis TN-Weekend 2
Aug 14-16 2009 Portland OR-Weekend 1 Mar 19-21 2010 Portland OR-Weekend 2
Sep 11-13 2009 Louisville KY-Weekend 1 Mar 5-7 2010 Louisville KY-Weekend 2
Sep 11-13 2009 Milwaukee WI-Weekend 1 Apr 23-25 2010 Milwaukee, WI-Weekend 2
Sep 25-27 2009 Columbia SC-Weekend 1 May 14-16 2010 Columbia SC-Weekend 2
Sep 25-27 2009 Needham MA-Weekend 1 Apr 16-18 2010 Needham MA-Weekend 2
Sep 25-27 2009 Los Angeles CA-Weekend 1 May 21-23 2010 Los Angeles CA-Weekend 2
Oct 9-11 2009 Phoenix AZ-Weekend 1 Apr 23-25 2010 Phoeniz AZ-Weekend 2
Oct 23-25 2009 Cheyenne WY-Weekend 1 Mar 12-14 2010 Cheyenne WY-Weekend 2
Nov 20-22 2009 Iselin NJ-Weekend 1 Feb 26-28 2010 Iselin NJ-Weekend 2
Dec 4-6 2009 Bloomington MN-Weekend 1 Apr 30-May 2 2010 Bloomington MN-Weekend 2
Jan 8-10 2010 Burlingame CA- Weekend 1 Aug 27-29 2010 Burlingame CA- Weekend 2
Jan 29-31 2010 Orlando FL-Weekend 1 Jun 4-6 2010 Orlando FL-Weekend 2
Jan 29-31 2010 Rosemont IL-Weekend 1 May 21-23 2010 Rosemont IL-Weekend 2
Feb 19-21 2010 Seattle WA-Weekend 1 Aug 6-8 2010 Seattle WA-Weekend 2
Feb 26-28 2010 Ann Arbor MI-Weekend 1 Jun 25-27 2010 Ann Arbor MI-Weekend 2
Mar 5-7 2010 Charlotte, NC-Weekend 1 Aug 20-22 2010 Charlotte NC-Weekend 2
Mar 26-28 2010 Phoenix AZ-Weekend 1 Aug 20-22 2010 Phoenix AZ-Weekend 2
Apr 9-11 2010 Omaha NE-Weekend 1 Oct 15-17 2010 Omaha NE-Weekend 2
Apr 9-11 2010 Bloomington MN-Weekend 1 Nov 12-14 2010 Bloomington MN-Weekend 2
Apr 30 - May 2 2010 Philadelphia PA-Weekend 1 Oct 22-24 2010 Philadelphia PA-Weekend 2
May 14-16 2010 Columbus OH-Weekend 1 Oct 22-24 2010 Colombus OH-Weekend 2
May 14-16 2010 Portland ME-Weekend 1 Nov 12-14 2010 Portland ME-Weekend 2
Jun 4-6 2010 San Diego CA-Weekend 1 Nov 19-21 2010 San Diego CA-Weekend 2
Jun 4-6 2010 Atlanta GA-Weekend 1 Oct 15-17 2010 Atlanta GA-Weekend 2
Jun 25-27 2010 Denver CO-Weekend 1 Dec 3-5 2010 Denver CO-Weekend 2
Jun 25-27 2010 Buffalo NY-Weekend 1 Nov 5-7 2010 Buffalo NY-Weekend 2
   

 
First Name:    
Last Name: Degree:
Address: Professional License:
  License #:
** Interns/Graduate Students see above.
City    
State: Business Phone:
Postal/Zip: Fax Phone:
Country: Home/Cell Number:
E-Mail Address:    
List 3 clinical specialties for the referral database:    
  1.  
  2.  
  3.  
 
Fees
Select Payment Option:
Registering for Weekend 1 & 2 in One Payment
Please register for Weekend 1 and 2 separately choosing the discounted rate.
You will be charged ONLY one time for both trainings.
US$1530 ($765/Weekend) if registering for Weekend 1 and 2 in one payment and received 15 days or more before seminar date
US$1598 ($799/Weekend) if registering for Weekend 1 and 2 in one payment and received 14 days or less before seminar date
US$850/weekend if registering for only one weekend and received 15 days or more before seminar date
US$925/weekend if rregistering for only one weekend and received 14 days or less before seminar date
Intern/Graduate Student, Full-time Nonprofit (Community Mental Health) Employee or Groups of 6+
US$1400 ($700/Weekend) if registering for Weekend 1 and 2 in one payment and received 15 days or more before seminar date
US$1464 ($732//Weekend) if registering for Weekend 1 and 2 in one payment and received 14 days or less before seminar date
US$775 if registering for only one Weekend and received 15 days or more before seminar date
Submit letter from supervisor confirming supervision with his/her signature and license number
US$850 if registering for only one Weekend and received 14 days or less before seminar date
Submit letter from supervisor confirming supervision with his/her signature and license number

Intern/Graduate Student: Submit letter from supervisor confirming supervision with his/her signature and license number (Fax to 831-761-1204)

Full-time Nonprofit Employee: Submit letter on agency letterhead verifying full-time employment (Fax to 831-761-1204)
Groups of 6+: Must submit registration together

Required and Suggested reading. Required reading is discounted with registration.
 
Qty Book Title AuthorPrice
Eye Movement Desensitization
and Reprocessing: Basic Principles,
Protocols and Procedures
- Required reading for workshop participants 		Francine Shapiro, PhD $63 Each
$55 Each
 
      
EMDR: The Breakthrough Therapy
for Overcoming Anxiety,
Stress and Trauma
- Required reading for workshop participants 		Francine Shapiro, PhD
& Margot Silk Forrest		 $18 Each
$15 Each
 
      
Handbook of EMDR and
Family Therapy Processes
- Required reading for workshop participants		 Edited by
Francine Shapiro
Florence W Kaslow &
Louise Maxfield		 $55 Each
$49 Each
      
EMDR as an Integrative
Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism 		Edited by
Francine Shapiro, PhD		 $50 Each
$45 Each
 
       
EMDR and The Art of Psychotherapy With Children
If purchasing this book and the treatment manual, a discounted rate of $72 will be charged for both.		 Robbie Adler-Tapia, PhD; Carolyn Settle, MSW $55 Each
       
EMDR and The Art of Psychotherapy With Children: Treatment Manual
If purchasing this book and "EMDR and The Art of Psychotherapy With Children", a discounted rate of $72 will be charged for both.		 Robbie Adler-Tapia, PhD; Carolyn Settle, MSW, LCSW $25 Each
      
Through The Eyes of a Child Robert Tinker, PhD
and Sandra Wilson, PhD		 $37 Each
      
EMDR in the Treatment of
Adults Abused as Children		 Laurell Parnell, PhD $30 Each
      
EMDR and Psychotherapy Integration Howard Lipke, PhD $50 Each
      
Light in the Heart of Darkness:
EMDR and the Treatment of
War and Terrorism Survivors		 Steve Silver, PhD & Susan Rogers, PhD$32 Each
     
EMDR and the Relational Imperative: The Therapeutic Relationship in EMDR Treatment Mark Dworkin $45 Each
       
EMDR Solutions: Pathways to Healing Robin Shapiro LICSW $37 Each
       
Healing the Heart of Trauma and Dissociation Carol Forgash & Margaret Copely $50 Each
       
Letting Go of Stress Emmett Miller, M.D. & Steven Halpern $16 Each
       
Looking Through The Eyes of Trauma and Dissociation Sandra Paulson $35 Each
       
EMDR Scripted Protocols: Basics and Special Situations Marilyn Luber $65 Each
       
EMDR Scripted Protocols: Special Populations Marilyn Luber $85 Each
   
An EMDR Primer Barbara Hensley, EDD $50 Each
   
 

Video/Audio Tapes
      
Brief Therapy Inside Out $80 Each
      
EMDR: A Closer Look (plus 40 page manual) $95 Each
      
EMDR For Trauma - APA Psychotherapy Videotape Series II $99 Each
     
CD - Forgiveness by Stephen and Ondrea Levine $13 Each
     
CD - Lovingkindness by Stephen and Ondrea Levine $13 Each
     
CD - Letting Go of Stress by Emmett Miller $16 Each
     
CD - Soft Belly by Stephen and Ondrea Levine $16 Each
   
Shipping Choice: *** (Please Select)
Please check if you are shipping to California California shipping adds 9.25% sales tax

A US$35 transfer fee will apply if registration fee is moved to another seminar/location. Tuition is refundable up to 14 days before the workshop dates, less a US$60 processing fee. No refunds will be made thereafter. Requests for refunds must be made in writing.

Please allow 10-14 business days to process your registration. A confirmation letter with details about venue and agenda will be sent with your receipt of payment.

Previous attendants of the Level I or Level II may attend at half price.

Method of Payment
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Name of Card Holder:
Card Number:
Expiration (MM/YY):
  Transaction cannot be processed without expiration date.
    
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Continuing Education:
20 CE Credits for each weekend of training
APA: EMDR Institute, Inc., is approved by the American Psychological Association to sponsor continuing education for psychologists. EMDR Institute, Inc., maintains responsibility for this program and its contents.
NBCC: EMDR Institute, Inc. is an approved provider through the National Board of Certified Counselors: NBCC Provider 5558.
RN: EMDR Institute, Inc., is a provider approved by the California Board of Registered Nursing, Provider Number 9755, for 20 contact hours.
BBS: For California the course meets the qualifications for 20 hours of continuing education credit for MFT's and LCSW's as required by the California Board of Behavioral Sciences. Approval No: PCE270.
SW: Pending in states where available. SW agencies outside the state in which the training occurs may or may not accept transferral of units depending upon individual state agency policy.


Contact Information:
EMDR Institute, Inc.
PO Box 750,
Watsonville, CA
95077 * USA
email: inst@emdr.com
Tel: (831) 761-1040 *
Fax: (831) 761-1204
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