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 That You Will Use to Sign the Participants Agreement(Required)
Legal name will be printed on certificates and used for all communication.
This needs to be a US/Canada cell phone number that can receive text messages and will be used during training.
SMS Consent(Required)
Mailing Address to Receive Training Manuals
Are you licensed(Required)
If you are Intern / Student / Associate / Provisional please put N/A in this field. If "Other" please provide license type.
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