Brainspotting Consult with Staci

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First and Last Name *

Email Address *

Phone Number *

Credentials/ Field of Work: *

What brainspotting trainings have you completed? *

Are you working towards BSP certification? *

Yes

Required

If yes, what consultant do you with with?

Are you looking for a consultant to work towards BSP certification and would like contact by one of our consultants? *

Yes

Required

How did you hear about this group? *

Financial Information

Card Number *

Expiration Date *

Address for Card *

Consent:

Drew’s Place Psychotherapy Services, Inc. and the included hosts of this group will not use personal information submitted to this form for any purpose other than the purpose of registration for this group or any requested contact made in the registration information.

Your registration and consent is not considered complete until you add your name below and click “Submit”. Payment will be ran upon receival of registration. An email receipt and link to the webinar will be provided through the email address provided on the registration form.

Submit

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