VERNAL EMDR TRAINING SUMMER 2021 - Cimpress
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VERNAL EMDR TRAINING SUMMER 2021
This is a fillable PDF form. Please fill out the registration form found
on page 5 and if applicable payment agreement on page 6 and email
to emdr808pacific@gmail.com
Alternatively, you can print, fill out and mail or fax to:
EMDR 808 Pacific Counseling
38 E 100 N Ste. B,
Vernal, UT 84078
Fax: (435) 604-73562
Advanced Education Institute EMDR Therapy Training
Course Trainer: Rhonda Kamai-Kekela, LCSW
adapted from DaLene Forester
EMDR International Association Trainer and Approved Consultant
This is the complete EMDR Therapy Training approved by EMDRIA, formerly known as Level I and
Level II. Participants will learn the EMDR psychotherapy approach, the basic eight-phase EMDR
protocol, the Adaptive Information Processing Model, and how to incorporate EMDR into your practice.
This course will consist of didactic presentations, demonstrations, supervised practicum, and case
consultations. Participants must attend the full training and five 2-hour consultation groups to receive a
certificate of completion in EMDR Therapy. Approval of partial programs will not be granted.
Required Reading: Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and
procedures, third edition, by Francine Shapiro, PhD, EMDR Therapy originator.
Qualifications for Attendance: A clinical background is essential for the effective application of
EMDR. Attendance at the workshop is limited to mental health professionals who, at a minimum, are
enrolled in the practicum phase of a Master’s degree or Doctoral degree. This course is appropriate for
licensed and pre-licensed mental health professionals including Psychologists, Marriage and Family
Therapists, Clinical Social Workers and Professional Clinical Counselors.
Training Information: This is a 2 Part training consisting of 3 days each, 6 days total.
Part 1: May 20th - 22nd
Part 2: July 29th – 31st
Schedule:
Part1:
Thursday 8:30 am - 5:00 pm
Friday 8:30 am - 5:00 pm
Saturday 8:30 - 5:00 pm
Part 2:
Thursday 8:30 am - 5:00 pm
Friday 8:30 am - 5:00 pm
Saturday 8:30 - 4:00 pm
Trainings start promptly at 8:30 am, coffee and morning treats served at 8:00 am each day. Please arrive
before the scheduled start time to sign in.3
Training Location: Check website for training location and please check that the registration form has
the correct location and dates you will be attending. After you have registered and submitted payment
you will receive a pre training email containing the address and directions to the training location if it is
not specified on the website.
Consultation: Each attendee must attend five 2-hour group consultations in addition, to the 6 training
sessions.
Consultation with EMDR 808 Pacific Counseling is included in the cost of the training. Listed below
are our assigned consultation dates for this training, you should make every effort to attend. Zoom
Teleconference is used for those out of the area, or you may participate in person at 38 E 100 N Ste. B,
Vernal, UT.
Zoom link will be emailed to you prior to the consultation time.
• Saturday, June 12, 2021
9:00 AM-11:00 AM MST
• Saturday, July 17, 2021
9:00 AM-11:00 AM MST
• Saturday, August 21, 2021
9:00 AM-11:00 AM MST
• Saturday, September 18, 2021
9:00 AM-11:00 AM MST
• Saturday, October 2, 2021
9:00 AM-11:00 AM MST
Mainland Cost: $1550.00 ($100 discount for pre-licensed individuals and non-profit).
Hawaii Cost: $1750.00 ($100 discount for pre-licensed individuals and non-profit).
Payment Plan: A payment plan of 3 equal payments is available. If you choose this payment option,
please fill out the form on page 6 and return it with your registration form.
About the Trainer: Rhonda Kamai-Kekela, LCSW, is an EMDR International Association Approved
Consultant and Trainer. She has a private practice in Vernal, UT, is a DOT SAP, supervises a therapist
and specializes in the treatment of anxiety, depression and C-PTSD. In addition to her psychotherapy
practice, Rhonda Kamai-Kekela, is a Tri-County Area Utah EMDR Regional Coordinator and a
volunteer EMDR HAP & EMDR Institute training facilitator.4
Continuing Education:
NBCC: A
NBCC: AEI
EI (Advanced EducationInstitute)
(Advanced Education Institute)has
hasbeen
beenapproved
approvedbybyNBCC
NBCCasasanan Approved
Approved Continuing
Continuing Education Provider, ACEP No. 6657. Programs that do not qualify
Education Provider, ACEP No. 6657. Programs that do not qualify for NBCC credit are clearly for NBCC credit
are clearlyAEI
identified. identified.
is solelyAEI is solely for
responsible responsible
all aspectsfor
ofall
theaspects of theNBCC
program(s). program(s).
creditsNBCC creditsbyare
are accepted the
accepted by
California BBS.the California BBS.
Psychologists: Advanced Education Institute (AEI) is approved by the California Psychological
NASW: "This
Association programcontinuing
to provide is Approved by the National
professional educationAssociation of SocialAEI
for psychologists. Workers (Approval
maintains #
responsibility
for this program andfor
886813866-1119) its41.5
content.
continuing education contact hours."
NASW: "This program is pending Approved by the National Association of Social Workers."
Receive credits for this training provided by AEI an approved CE provider with EMDRIA, NBCC and
CPA. For more information, call 435-219-0576.
Attendance at the entire program is required for CE Credit. No partial Credit will be awarded.
Please register early and arrive before the scheduled start time. Space is limited. Registrants canceling
up to 72 hours before the workshop will receive a tuition refund less a $50.00 administrative fee. No
refund for less than 72 hours cancellation. A $25.00 service charge applies to each returned check.
MasterCard and Visa accepted. All trainings by Rhonda Kamai-Kekela, LCSW are held in facilities in
accordance with the Americans with Disabilities Act. If special accommodations are required, please
notify Rhonda Kamai-Kekela, LCSW 72 hours in advance.
Note: temperatures in meeting rooms are variable, please dress in layers.5
EMDR Therapy Training Registration
Please return this registration form by mail, fax or email to:
EMDR 808 Pacific Counseling
38 E 100 N Ste. B, Vernal, UT 84078
Phone: (435) 219-0576 Fax: (435) 604-7356
Email: emdr808pacific@gmail.com
Training Dates Part 1: May 20th – 22nd
Training Location- City/State: Vernal, Utah
Please double check dates and location before registering and submit official transcript if you are a 2nd year
master’s student, or higher.
Name: ______________________________________________________________________
Profession or Title: ____________________________________________________________
Please print your name as you want it to appear on your Certificate of Completion:
____________________________________________________________________________
Professional Lic. #____________________________________________________
State Licensed Issued: ____________________ Lic. Exp. Date: _________________
Mailing
Address:____________________________________________________________________________
City: ______________________________State: _________ Zip: _____________
Contact Phone: (____)__________________________________________________________
Email:_______________________________________________________________________
Please select form of payment.
_______Check
Payment by check may be made payable to EMDR 808 Pacific Counseling at 38 East 100 North Suite
B, Vernal, UT 84078
_______Card
Payment by debit or credit card can be made online at https://emdr808pacific.com/ via PayPal by
selecting the appropriate training, date and location.
_______Payment Plan
Please submit payment plan agreement found on the next page and 1st payment with this form.
Please tell me how you heard about this training
____________________________________________________________________________
Signature:
____________________________________________________________________________6
38 EAST 100 NORTH SUITE B, VERNAL, UT, 84078-2122
TEL: (435) 219-0576, FAX: (435) 604-7356
E-MAIL: EMDR808PACIFIC@GMAIL.COM
Utah Training Payment Agreement
Name_____________________________________Date_______________________
Mailing Address:_______________________________________________________
City: ______________________________State: ___________ Zip: ______________
Contact Phone: (____)________________Email:______________________________
Training Date and Location May 20th – 22nd 2021 Vernal, Utah
Please select the payment option that applies to you:
___ $1500.00
1550.00 Full Licensure
1/3 payment of $516.67 due at registration to hold your seat
2/3 payment of $516.67 due immediately following training Part 1
Final payment of $516.67 due immediately following training Part 2
___ $1450.00 Non-Profit and Pre-Licensed
1/3 payment of $483.33 due at registration to hold your seat
2/3 payment of $483.33 due immediately following training Part 1
Final payment of $483.33 due immediately following training Part 2
I, ____________________________________ agree to abide by the above selected payment arrangement.
Payments are to be made to EMDR 808 Pacific Counseling, Rhonda Kamai-Kekela, for EMDR Therapy Basic
Training. I agree to satisfy the payments at the specified times and understand that failure to pay may result in the
denial of attendance and/or the withholding of training completion certificate.
__________________________________ __________________________________
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