Brainspotting to Heal Shame, Self-Esteem & Imposter Syndrome
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Date Registering for: *
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Are you interested in volunteering as a demo?  *
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First and Last Name *
Email Address *
Credentials/ Field of Work *
Phone Number - to be accessible during training *
What brainspotting trainings have you completed? *
Have you completed Phase 1? *
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If yes, who were you trained by? *
Are you BSP certified? *
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Are you working towards BSP certification? *
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Are you looking for a consultant to work towards BSP certification and would like contact by one of our consultants? *
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How did you hear about this training?
Are you a student? *
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If yes, school attending, projected date of graduation and degree?
Financial Information
Card Number *
Expiration Date  *
Address for Card 
(please use full address, including City, State & Zipcode)
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Consent:

I am aware in registering that part of the learning model includes demonstration and practicum experiences. Participants will hold the space as both a clinician and a client during the practicum to further support skill building, attunement, and personal development.


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


I hereby grant permission via this form for Drew’s Place Psychotherapy Services, Inc.  to record the training and to use, adapt, modify, digitize, reproduce, broadcast, transmit, exhibit, post, and perform, in any form now existing or later developed, the training, including without limitations on the Drew’s Place website or media outlets,  website or media outlets, without restriction as to frequency or duration of usage.

 

I hereby acknowledge and commit to holding provided training material and information to the registered participant. I acknowledge and commit to holding a secure, safe space for participant sharing, respecting the privacy of the group and the personal sharing offered as a means to further support the learning process within this training.


Refund Policy: Full refund up to 30 days out of training date. 75% refund within a week or scheduled training.


PLEASE NOTE: $6.50 service fee will be added to all registrations.


Your registration and consent is not considered complete until you add your name below and click “Submit”. 

Payment will be ran by Friday upon receival of registration. An email receipt and link to the training will be provided through the email address provided on the registration form. Additional resources will be provided through a secure, password protected Resource Page for the training. The Resource Page will be available for 30 days following the registered training date. A recording of the training will be provided to registered participants after the training.

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