EFT Event Registration 4

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 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).

Early Bird applies until:

Rate:*

Regular Rate, all 4 sessions: $1,700.00 USD
Equity Rate: self-selected increments of $100, base of $800

Equity Rate: This registration option is for participants with historical/institutional barriers to access. Please choose equity pricing only if you are a member of one or more historically marginalized communities.

Equity Rate (select quantity 0-8):*

Price: $100.00 Quantity:

Select the number of $100s to be added to the base of $800 from 0-8 — e.g. to pay $800, select 0; to pay $1,200, select 4; to pay $1,600, select 8.

Agency/School:

Additional Rate for CEs:*

CEs $25.00 USD
No CEs $0.00 USD

Coupon:

Payment Method:*

Credit Card or PayPal

How did you hear about this workshop?*

CFINE Email
CFINE 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