Booking form Workshop registration Workshop registration Given Name * First Family Name * Last Mobile Phone (for WhatsApp). NB unfortunately this form will not work on a smartphone. Requires completing on a computer. Sorry! * Email * Confirm Email * Level of EMDR Training – Note that you cannot join our workshops/webinars unless you are fully trained in basic Standard Protocol EMDR. * At least Part 3 (Part 2 in AU/NZ/US) Accredited Practitioner Accredited Consultant Accredited Trainer 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. * What do you want to do? * Book a workshop Just getting in touch Which EMDR Insight workshop are you wanting to book? * June 26-28, 2023: Unleash Retreat Part 1 Oct 23-25, 2023: Unleash Retreat Part 2 tbc AI-EMDR with Addictions Which EMDR Insight workshop are you wanting to book? How would you primarily describe yourself? * Psychotherapist Psychologist Psychiatrist Social worker Nurse Client booking workshop: freedom from compulsive behaviours OtherOther What IFS experience do you have? * None Read a book Attended IFS Part 1 Training IFS certified Experienced IFS therapy Primary Accrediting Organisation (e.g. UKCP, BACP, BABCP, BPS, APS etc). NOTE THAT THIS IS NOT YOUR NATIONAL EMDR ASSOCIATION. Please ignore this if you’re registering for a client workshop. 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? * Australia/NZ UK USA EU Rest of the world How did you hear about this Workshop? * By registering for an EMDR Insight 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 this list, EMDR Insight will observe all requirements of GDPR and data protection. * Yes No Time 121234567891011 : 0030 AMPM If you are human, leave this field blank. Submit Δ