Registration Form - Graceway Counseling Center

Preferred Name on Name Badge

First

Last

Name on Certificate of Completion

First

Last

Please tell us the name you would like to appear on your certificate of completion.

Email

Phone Number

Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

License Type, State & Number

What is your profession or license type, license state and license number?

Accommodations Requested

Are there any accommodations you would need to help you be comfortable during the training?

Policy Agreement on

Food & Allergies

It is common for us to provide light snacks. Do you have any life-threatening food allergies we should know about so that we do not provide those types of foods/snacks.

Confidentiality Statement

I agree to the following statement.

An important part of learning in EFT is seeing it unfold in action by watching live unscripted psychotherapy and consultation sessions. All personal content of the large group and small group, and all clinical material shown during this training is confidential. As a participant, you agree to keep confidentiality.

Refund Policy

I understand and accept.

Refund Policy: 80% refund up to one month prior to training. No refund after one month prior to training unless the spot can be filled.

Subject Privacy

I agree to the following statement.

To protect the privacy of the individuals who have generously agreed to have their therapy process shown for training purposes, I agree that if I recognize any person in the clinical cases shown, I will let the facilitators know so that they can provide an alternative training video for me to learn from.

No Recording Agreement

I agree to the following statement.

I agree to not record any part of this training in any format (audio, video, or visual). Personal handwritten or typed notes of non-confidential material are permitted.

Order Information

Please select the appropriate box

Early Bird Rate - Core Skills 1 & 2 - August 21-23 2025 - $900.00
Early Bird Rate - Core Skills 3 & 4 - January 15-17, 2026 - $900.00
Early Bird Rate - Both Trainings (Save $100) - $1,700.00

Early Bird Rate good thru June 30, 2025. Limited spots available.

Total Amount

$0.00

Payment Information

Special Delivery Instructions