Unleash Part 1 Booking Form

Given Name *

Family Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Phone - ideally mobile. Note that this needs to be entered without spaces. Please include your country code (eg +44 for UK, +1 for US/Canada, +61 for Australia) *

Please choose from the following Part 1 dates.

Level of EMDR Training - Note that you cannot generally join our workshops/webinars unless you are fully trained in basic Standard Protocol EMDR. *

Not EMDR trained

Still training (Part 1 only)

At least Part 3 (Part 2 in AU/NZ/US)

Accredited Practitioner

Accredited Consultant

Accredited Trainer

OtherOther

What year did you complete your Basic EMDR Training (Part 3/4 in UK, Part 2 in US & Aus/NZ). Note that these workshops are open only to colleagues already fully trained in basic EMDR. *

Who did you do/are you doing your basic EMDR training with (individual Trainer's name or company)? Note that generic answer e.g. NHS is insufficient. *

If not yet fully trained in Basic EMDR, add a few words here to help us decide whether participation in our own Part 1 might be OK for you (noting that completion of basic EMDR training is otherwise normally a requirement for joining us here).

How would you primarily describe yourself? *

Primary Accrediting Organisation (e.g. UKCP, BACP, BABCP, BPS etc) NOTE THAT THIS IS NOT YOUR NATIONAL EMDR ASSOCIATION. *

Working online only, or also in-person (optional)

Online Only

In-Person only

Both Online and In-Person

Address (optional, but helpful - will not be shared onwards)

City

State/Province

Zip/Postal

Country

Where are you registered for tax purposes?

How did you hear about EMDR Focus/this Workshop? *

By registering for an EMDR Focus workshop, and recognising that participation can involve both observation and personal experience of sometimes profound trauma processing, I agree to take appropriate responsibility for my own emotional wellbeing, and to ensure I have access to any necessary therapeutic and/or supervisory support following the workshop. *

Yes

No

By ticking the Yes box below, I acknowledge that in managing the information in this form, EMDR Focus Ltd will observe all requirements of GDPR.

Yes

No

Payment Options

I will pay immediately using credit/debit card, please take me to the necessary page. (NB if paying in USD, your credit card will calculate the necessary day rate to GBP. Note that this may be a few dollars either side of $600)

I need a separate invoice for the organisation paying for this.

I wish to pay in instalments (by prior agreement only)

I've already done Unleash Part 1 and am joining as a refresher at a discounted price of £295.

If you're attending as a refresher, please tell us here when you last did Unleash Part 1.

If requesting to pay in instalments, some words of explanation.

Credit Card