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Unleash Part 1 Booking Form
Michael Griffiths
2021-12-05T13:59:41+00:00
1. New - Unleash Part 1
Given Name
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Family Name
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Email
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Enter Email
Confirm Email
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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)
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Please choose from the following Part 1 dates.
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Fri-Sun July 22-24, 2022. (UK/AUS timings). £456/AUD800 approx..
Wed-Fri Sept 7-9, 2022. (UK/US timings). £456/US$600 approx
Fri-Sun Jan 20-22, 2023. (UK/AUS timings). £456/AUD800 approx.
Fri-Sun March 31-April 2, 2023. (UK/US timings). £456/ US$600 approx
Level of EMDR Training - Note that you cannot generally join our workshops/webinars unless you are fully trained in basic Standard Protocol EMDR.
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Not EMDR trained
Still training (Part 1 only)
At least Part 3 (Part 2 in AU/NZ/US)
Accredited Practitioner
Accredited Consultant
Accredited Trainer
Other
Other
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.
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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.
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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?
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Psychotherapist
Counsellor
Psychologist
Psychiatrist
Nurse
Other
Other
Primary Accrediting Organisation (e.g. UKCP, BACP, BABCP, BPS etc) NOTE THAT THIS IS NOT YOUR NATIONAL EMDR ASSOCIATION.
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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)
Address (optional, but helpful - will not be shared onwards)
Address (optional, but helpful - will not be shared onwards)
Address (optional, but helpful - will not be shared onwards)
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Where are you registered for tax purposes?
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UK
EU
Australia/NZ
USA/Canada
Rest of World
How did you hear about EMDR Focus/this Workshop?
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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.
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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.
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Yes
No
Payment Options
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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.
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Credit Card
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