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-Weekend 1 Training Dates-Weekend 2
Jan 25-27 2008 San Francisco CA-Weekend 1 Jun 6-8 2008 San Francisco CA-Weekend 2
Feb 1-3 2008 Seattle WA-Weekend 1 May 30-Jun 1 2008 Seattle WA-Weekend 2
Feb 8-10 2008 Novi MI-Weekend 1 May 16-18 2008 Novi MI-Weekend 2
Feb 8-10 2008 Charlotte NC-Weekend 11 Jun 6-8 2008 Charlotte NC-Weekend 2
Feb 8-10 2008 Phoenix AZ-Weekend 1 Jul 11-13 2008 Phoenix AZ-Weekend 2
Mar 14-16 2008 Omaha NE-Weekend 1 May 30-Jun 1 2008 Omaha NE-Weekend 2
Mar 28-30 2008 Calgary AL CAN-Weekend 1 Aug 15-17 2008 Calgary AL CAN-Weekend 2
Apr 11-13 2008 Memphis TN-Weekend 1 Jul 11-13 2008 Memphis TN-Weekend 2
Apr 11-13 2008 Milwaukee WI-Weekend 1 Aug 15-17 2008 Milwaukee WI-Weekend 2
Apr 25-27 2008 Toronto ON CAN-Weekend 1 Oct 24-26 2008 Toronto ON CAN-Weekend 2
May 2-4 2008 Philadelphia PA-Weekend 1 Oct 24-26 2008 Philadelphia PA-Weekend 2
May 30-Jun 1 2008 Atlanta GA-Weekend 1 Oct 17-19 2008 Atlanta GA-Weekend 2
Jun 20-22 2008 Denver CO-1 Oct 17-19 2008 Denver CO-2
Jun 20-22 2008 Columbus OH-Weekend 1 Oct 3-5 2008 Columbus OH-Weekend2
Jun 27-29 2008 Portland ME-Weekend 1 Oct 3-5 2008 Portland ME-Weekend 2
Jun 27-29 2008 San Diego CA-Weekend 1 Oct 24-26 2008 San Diego CA-Weekend 2
Jul 18-20 2008 S. San Francisco CA-Weekend 1 Nov 14-16 2008 S. San Francisco CA-Weekend 2
Jul 18-20 2008 Austin TX-Weekend 1 Nov 21-23 2008 Austin TX-Weekend 2
Jul 25-27 2008 Bloomington MN-Weekend 1 Dec 5-7 2008 Bloomington MN-Weekend 2
Aug 1-3 2008 Phoenix AZ-Weekend 1 Jan 30-Feb 1 2009 Phoenix AZ-Weekend 2
Aug 8-10 2008 Portland OR-Weekend 1 Feb 27-Mar 1 2009 Portland OR-Weekend 2
Aug 8-10 2008 RTP NC-Weekend 1 Dec 5-7 2008 RTP NC-Weekend 2
Aug 22-24 2008 Atlanta GA-Weekend 1 Mar 13-15 2009 Atlanta GA-Weekend 2
Sep 26-28 2008 Stamford CT-Weekend 1 Mar 20-22 2009 Stamford CT-Weekend 2
Sep 26-28 2008 Arlington Heights IL-Weekend 1 Apr 3-5 2009 Arlington Heights IL-Weekend 2
Oct 3-5 2008 Missoula MT-Weekend 1 Mar 13-15 2009 Missoula MT-Weekend 2
Oct 10-12 2008 Clayton MO-Weekend 1 Feb 27-Mar 1 2009 Clayton MO-Weekend 2
Nov 14-16 2008 Iselin NJ-Weekend 1 Feb 20-22 2009 Iselin NJ-Weekend 2
Nov 21-23 2008 Orlando FL-Weekend 1 Mar 13-15 2009 Orlando FL-Weekend 2
Dec 5-7 2008 Denver CO-Weekend 1 Jun 12-14 2009 Denver CO-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 $55 Each
$49 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
       
 

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
     
   
Shipping Choice: *** (Please Select)
Please check if you are shipping to California California shipping adds 8% 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
Credit Card Type:     Note: Only these cards are accepted.
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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