EFT Event Registration 2

EFT Event Registration 2Lindsay Swan2020-03-04T17:21:53+00:00

Workshop Name:*
Name:*
First Last
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:*
Email:*
License Type:*
- LICSW
- Lic. Psychologist
- LMFT
- LMHC
- Student or Unlicensed Professional
- Other (please describe):
*
Agreements:*
- I have the training and educational qualifications to legally practice as a professional mental health practitioner or I am in formal training to be a professional mental health practitioner.
- I have previously completed the Externship in EFT training.
- I agree to not record any part of this training in any format (audio, video, visual). Personal written notes of non-confidential material are permitted.
- I agree to excuse myself from any video or live therapy sessions where I recognize any of the clients, and according to the ethics of my profession, will keep confidential the personal identifying information of case material shared in this training.
- I agree to attend the training module in its entirety (48hrs).
Please list the location, instructor, and year of your Externship.*
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Early Bird applies until:
Equity Rate Option
- I identify as Black/African American.
- I do not identify as Black/African American.
The Equity Rate registration option is for participants identifying as Black/African American.
Regular Rate:*
- Regular Rate: $1,700.00 USD
Equity Rate:*
- Equity Rate: $1,600.00 USD
- Equity Rate: $1,500.00 USD
- Equity Rate: $1,400.00 USD
- Equity Rate: $1,300.00 USD
- Equity Rate: $1,200.00 USD
- Equity Rate: $1,100.00 USD
- Equity Rate: $1,000.00 USD
Please choose the highest rate you can comfortably afford such that CFINE is able offer this Equity Rate to a greater number of participants.
Equity Rate (select a multiple of $25.00):
Price: $25.00
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Agency/School:
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Additional Rate for CEs:
- CEs $20.00 USD
- No CEs $0.00 USD
Payment Method:*
- Credit Card or PayPal
How did you hear about this workshop?*
- CFINE Email
- CFINE Website
- ICEEFT Website
- NEEFT Website
- Word of Mouth
- Other (please describe):
*
Join our mailing list to learn about upcoming programs and discounts:*
- Yes, please!
- No, thanks
Total:
$0.00