ST. George Externship Registration Form - 2023
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Email *
Preferred Email *
Full Name *
Preferred Mailing Address, (city/state-region/country/zip) *
Mobile Phone Number *
Designation: List what applies to you
License Type (include state and license #) 
Associate (include state and assoc #)
Intern (Location and site)
Full Time Grad Student (Program and School)
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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.
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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 San Diego Center for Emotionally Focused Therapy, the Training and Research Institute for Emotionally Focused Therapy (TRI-EFT), 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.

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Required
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.
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Required
Do you want CE's? (we will follow up with you) *
Click here to pay now and reserve your spot. Pay now *
Click here to pay now and reserve your spot. You will be taken to Ut Tech.
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