Copy of Review Registration Information and Sign the Participant’s Agreement

Please review the registration information that we have on file.

Please correct any information below so that it is accurate. It is critical that we have a working cell phone and deliverable physical mailing address.

This field is read-only. To update please contact assist@emdr.com
Legal name will be printed on certificates and used for all communication.
Legal name will be printed on certificates and used for all communication.
This needs to be a cell phone that can receive text messages and will be used during training.
Mailing Address to Receive Training Manuals(Required)
Are you licensed(Required)
If you are a student or intern please put N/A in this field.
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