Webinar Registration


Registering for: Treating Complex Trauma with EMDR Therapy
and Structural Dissociation Theory: Effectively Treating Parts
Last Name:
First Name:
Middle:
Street:
City:
State:
ZIP Code:
E-Mail Address:
Phone Number:
Cell Phone:
Mental Health Professional License Number:
Are you trained in EMDR therapy?
When were you trained in EMDR therapy?
Who was your trainer?

Registration is Not Complete until Payment is Received