EMDR Canada

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Application

Membership*
- Professional
- Retired
- Student
- Associate
Contact Info
Name*
First Last
Mailing Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
Enter Email Confirm Email
Professional Information
Mental Health Degree*
Profession*
Professional Regulatory Body*
Registration #*
Registering Province*
I confirm that while being a member of EMDR Canada I will:*
- Hold a membership in good standing with my regulatory body
-Hold professional liability insurance
- I declare that these above conditions will continue to be met during the time I am a member of EMDR Canada.
EMDR Training
EMDR Designation*
If you would like to add another designation, please contact us after completing this form.
- EMDR Basic Training
EMDR Basic Training Date*
MM slash DD slash YYYY
Membership
Members Directory*
- List me in the directory
- Do not list me in the directory
Keep me informed of future workshops and trainings*
- Yes
- No
Journal EMDR Practice & Research
(Online journal is free)
- Printed journal
Preferred Language*
- English
- Français
REGIONAL COORDINATORS PROJECT
The Regional Coordinators are volunteers for EMDR Canada who organize group meetings of trained EMDR therapists for the purpose of sharing information and supporting each other. If you are interested in becoming a Regional Coordinator, a Board Member will contact you.
- Yes, I am interested in becoming a regional coordinator in my area.
- No thanks, I am not interested in becoming or continuing as a regional coordinator.
Member Directory
The information you provide here will be displayed in the member directory. Only fields marked with an asterisk are required.
Street Address
Apt/Suite/Office
City*
Province*
Postal Code*
Population served*
- Children
- Adolescents
- Adults
- Seniors
Required Qualifying Proof
Students: Please provide a copy of full-time student registration. All other members please provide a copy of your EMDR L2 Training Certificate.
I will provide this via:*
- Upload
- Fax
- Mail
EMDR L2 Training Certificate*
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
Registration Education Institute*
(full time)
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
Fax Instructions

514-522-1565
Mailing Instructions

EMDR Canada
CP 50004 CP Jarryl
635, rue Jarry Est Montreal, QC H2P 1V0
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Payment
Total
$ 0.00 CAD
Payment Method*
- Cheque or Money Order
- Credit Card
Mailing Instructions

EMDR Canada
CP 50004 CP Jarry 635, rue Jarry Est
Montreal, QC H2P 1V0
Credit Card*

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MasterCard
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
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MEMBERSHIP

Membership runs from November 1st till October 31st.
Join us or renew your membership.

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EMDR Canada
CP 50004 CP Jarry
635, rue Jarry Est
Montréal (QC) H2P 1V0

Tel: (514) 522-1555
Fax: (514) 522-1565

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