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? * Aug 30-Dec 13, 2024, UK: IFS informed EMDRAug 30-Dec 13, AUS/USA: IFS informed EMDRNov 11-13, 2024: Unleash Retreat Part 1Feb 10-12, 2025: Unleash Retreat Part 2 How would you primarily describe yourself? * Psychotherapist Psychologist Psychiatrist Social worker Nurse Client booking workshop: freedom from compulsive behaviours OtherOther When did you complete Attachment Informed/Focused EMDR Advanced training? * 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 AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Where are you registered for tax purposes? * Australia/NZUKUSAEURest 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 reCAPTCHA If you are human, leave this field blank. 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