INDIVIDUAL ENROLLMENT & PARTICIPANT AGREEMENT 2024 EMDR Review Course
The undersigned participant acknowledges that they have thoroughly and carefully read, understand, and agrees to the following. This course is only available to clinicians who have completed an EMDRIA approved EMDR basic training. Completion certificates are required to be sent in to alicia@aliciaavila.com along with this agreement and payment.
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Email *
Name and pronouns (Let me know if are using a different name than what you will need on your certificate) *
Licence type and number *
Office/Professional phone number *
Cell phone number if open to receiving texts (re:training updates) *
Date of EMDRIA approved basic training completion. *
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EMDRIA approved basic trainer provider: Trainer name and organization *
1. Participants must have completed an EMDRIA approved basic training. Basic EMDR training completion is 50 hours including the 10 basic training consultation hours. Please email your completion certificate to: alicia@aliciaavila.com along with this agreement. *
Required
2. No portion of this training is considered clinical supervision. Any suggestions or answers to questions are shared as general impressions on the application of the protocol and do not constitute clinical direction, advise, or supervision. While clinical possibilities may be discussed in relation to clinical situations, each therapist is solely responsible for the clinical management of the client/patient and is expected to exercise their best judgment in all relevant clinical matters.This training is not a substitution for clinical supervision or peer consultation.  *
Required
3. In order to assure confidentiality of personal and clinical information, audio/video recording by participants is not allowed. All participants are expected to maintain the highest ethical standards of confidentiality regarding all personal and clinical information shared by others in this training. 
Failure to maintain confidentiality shall be treated as a professional ethics issue, may be reported to a licensing board, and likely will result in immediate dismissal from the training program with no refund.  Confidentiality applies to client videos, clinical examples, demonstrations, and group activities. 
Please avoid using identifying information when discussing cases.  Clients who have given permission to have session recordings shared in this training deserve the utmost respect and confidentiality guarded by all who attend, and have not given permission for videos to be used outside of this training. 
Training materials are not to be distributed to others without written permission.
 *
Required
4.  Participants are expected to maintain a spirit of cooperation and mutual support for all in the training. Splitting and conflict-generating behavior will not be tolerated.  Participants who are disruptive to the training will be dismissed without refund. *
Required
5. Full attendance is required for CEU credits. Arriving late or leaving early will disqualify you from receiving credit  or CEU's for the course.  *
Required
6. If you withdraw or request to reschedule your training with 60 days or more notice you can obtain a refund less $75 administrative fee.  If you cancel or request to reschedule with less than 60 days of the training you can get a 50% refund of the full training fee. There is no refund for cancelling or rescheduling on or after the first day of training.   *
Required
7. This workshop is for clinical purposes only and will not qualify the participant to train others in EMDR.  Attempts to train others in EMDR without meeting the standards as defined by the EMDR International Association would represent a professional ethics violation. *
Required
8. If this is an in-person training: There is a possibility that you could contract COVID from someone at the training or at some point during the training.  If you are feeling ill you please take a COVID test and even if the test is negative, please wear a mask and keep a greater distance. You are encouraged to take safety precautions for your own health as well as to minimize the risk to others.  If you are too ill to attend, reach out to the trainer in case there is an option to attend virtually. *
Enter your name here as a signature and agreement to the above. *
Today's Date *
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Emergency contact name and phone number *
Any concerns, questions, or special requests *
3 options for payment. 
Early Bird Discount: Payment received BEFORE July 15 $340.
Payments received AFTER July 15 $390
1. Mail a check to: 
Alicia Avila Licensed Clinical Social Worker P.C. 
4629 Cass Street #368
San Diego, CA 29109
2. Pay through your online banking if they offer you an option to send payment/Zelle; Identify Alicia Avila as the recipient by name and using the email address: alicia@aliciaavila.com
3.  Pay by credit card using this link
*Group pricing requires completing the group enrollment agreement NOT this one.
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