A MyTraumaTherapy.com Web Directory of Certified EMDR Therapists
(or those who have completed at least 5 of their 20 hours of Consultation toward EMDRIA Certification)
Name ________________________________________ Title _______________________________________
Business Address ___________________________________________________________________________
City ______________________________________ Zip _______________________ State ______________
Business Phone ________________________________ Cell _______________________________________
Fax __________________________________________
Mail the following to MyTraumaTherapy, 3537 Boundary Street, San Diego, CA 92104:
- Registration Fee of $150
- Copy of my EMDRIA-Certification in EMDR, Approved Consultant, Facilitator, or Trainer Certification
- OR, a letter from my EMDRIA-Approved consultant stating I’ve completed at least 5 hours of consultation and giving the expected date of completion of my certification
- My professional license copy
- My liability insurance copy
I, _____________________________________________, understand the following:
- my registration fee is non-refundable
- when I receive email confirmation of approval, I will be given instructions to log in to the site and complete my profile online.Video tutorials will help me me with this process, and I can also make an appointment with Dana or Karen to be walked through the process by phone.
- when I log-in to activate my profile page, I must click on the “Subscription” button which takes me to PayPal to completed the enrollment for the monthly subscription fee of $29.00 This will be charged beginning one month from the date I log in (giving me one free month).
- I am free to make changes or edits after that at any time I need. I understand I can submit short articles to MyTraumaTherapy to promote my specialties and link to my Profile Page.
- If I have any questions or need assistance, I can contact Dana Terrell or Karen Walker at 619 283-5665, or by email at danaterrell.lcsw@gmail.com
My signature below signifies that I agree to all of the above terms.
Signature______________________________________________ Date _____________________
