Externship Registration Form

Please fill out the form below if you would like to sign up for the May 29th to June 1, 2019 Toronto Emotionally Focused Therapy Externship with Sue Johnson and Gail Palmer.

Your Name: *

Professional Designation/Title: *

Enter Your Email: *

Phone: *

Address Line One (Number and Street): *

Address Line Two(Apartment /Suite):

Address Line Three(City/Province/Country): *

Address Line Four (Postal Code/Zip Code): *

Participation Requirements** Participants must be familiar with and abide by professional and legal confidentiality requirements regarding all client information shared in the training. Certification in EFT is offered by ICEEFT based on completion of all requirements and demonstrated competence in the model. Completion of training does not guarantee competence or certification. Enrollment in this training constitutes an agreement to hold harmless The Greater Toronto EFT Community, and all presenters and trainers from any and all claims, actions, and judgements, including all costs of defense and attorney’s fees incurred in defending against the same. I have read and agree to follow the terms for participation. Yes *

I have the training and educational qualifications to legally practice as a professional mental health practitioner in the area I live OR I am in formal training to be a professional mental health practitioner. Yes *

I am interest in registering for the 2019 Emotionally Focused Therapy Externship. Yes?

Confidentiality Agreement: I agree to keep confidential the personal identifying information of case material shared in the training. I agree to not record any part of this training in any format (audio, video, or visual). Personal written notes of non-confidential material are permitted. Yes *

After you “Submit” this registration, you will need to go back to the Toronto Extenship page on this site to access the Paypal gateway for payment. We are delighted and honored that you will be joining us! Insert any comment or question here. Finalizing Your Registration/Comments or need Assistance:

I am aware that the 2019 Toronto Externship is being videotaped to be made into a training tape to be sold by ICEEFT and I am comfortable with this. Yes?

To qualify as a student, you must be enrolled in and currently attending an institution studying Psychotherapy, Social Work, Mariage and Family Therapy, Psychology or some equivalency. The name of the institution I am attneding is:

My graduation date is:

Degree:

How did you hear about the training: