EMDR Level II Registration Form

Name:______________________________________________

I have a Masters Degree   [EMDRIA Requirement]    Yes       No

Please attach a photocopy of your Masters Degree, EMDR Level 1 certificate, and a list of specialties

License Number: ___________   Association: _______________ 

Address:  _________________________________________     

Phone:______________ Fax: ____________ e-mail:_______________

Please Indicate Desired Location: 

Winter 2006:

February 23-25, 2006 (Thursday - Saturday)  Toronto

Fee:           Toronto  $ 700.00 + $49.00 GST *
                 
*(offer subject to change without notice)

Cancellation Policy There is a $50 cancellation fee any time up to 30 days before a workshop starts. The cancellation fee is $100 if cancellation notice is received with less than 30 days notice.  You may transfer your registration fee at no cost to an alternative workshop offered by Fraser Counselling, if space is available.

Make cheque payable to:    Susan Fraser  

Pay by:  Cheque      Visa  Visa # ___________________  

                                                Expiry ___/______

Name_____________________  Signature_______________________

Mail or fax to: Fraser Counselling Services               
For More About This or Future Workshops Contact Us: