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Registration form for Southwest Behavioral Health: EFFT EssentialsPlease submit one form for each attendee.Name of person completing this form(Required)EmailInput the group administrator email here to receive an email confirmation upon submission Agreement(Required) I agree with the policies listed on https://courses.iceeft.com/policies/ Attendee DetailsRegister attendee for the following 'EFFT Essentials'(Required) February 5-6 and 12-13 (Wed/Thur) April 3-4 and 10-11 (Thur/Fri) Attendee name(Required) First Last Attendee email(Required)A unique email address is required for each attendee to access their course. We will not send a confirmation email to attendees at this time. Attendee location(Required) City State / Province / Region Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Other than English, attendee works in the following language(s)Consent to share with local EFT Organization(Required)Upon completion of this course, ICEEFT may share attendee’s name and email address with their local EFT Community or CentreYes, I consentNo, I do not consentAttendee EligibilityAttendee is(Required) a professional mental health practitioner in the area they live. Attendee has the educational training, qualifications, and professional credentials to practice as a mental health professional in their area. a student training to become a professional mental health practitioner. Attendee is enrolled in and currently attending a degree program studying Psychotherapy, Social Work, Marriage and Family Therapy, Psychology or equivalent, and their studies include supervised internship. Attendee's field is(Required) Psychology, Psychotherapy, Psychiatry Social Work Marriage & Family Therapy Counselling Student of one of these mental health fields Other Attendee's professional designation is(Required)The answer may be ‘Student’.Attendee & EFTThe following statement(s) describe this attendee(Required)Select all that apply. New to EFT Had an introduction to EFT (eg, Fundamentals course, university, books) Taken EFIT (EFT for Individuals) training Taken EFCT (EFT for Couples) training Taken EFFT (EFT for Families) training Current/past ICEEFT Member Current/past connection with local EFT Community/Centre Wants to (re)take this course as a refresher Attendee decided to register for this event because(Required)Select all that apply. It was recommended (by mentor, colleague, a past participant, etc) It was required (for licensing hours, for a job, employer paid, etc) They need CEs They want to get certified in EFT (EFCT, EFIT, and-or EFFT) Of the specific trainer(s) involved They want to expand their practice into a new area (couple, family, or individual therapy) EFT is known to be effective; they want to learn more Attendee AgreementsAttendee agrees to(Required) keep confidential the personal identifying information of case material shared in the training. Attendee agrees(Required) not to record any part of this training in any format (audio, video, or visual); personal written notes of non-confidential material are permitted. Attendee accepts that(Required) recording this training may result in being asked to leave immediately without refund or compensation.
