Registration Form

July 19-22, 2020 with Elana Katz / November 8-11, 2020 with Veronica Kallos-Lilly
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Qualifications

I have the training and educational qualifications to legally practice as a professional mental health practitioner in the area I live OR I am in formal training to be a professional mental health practitioner.  I have also completed a live externship in Emotionally Focused Therapy. 

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Participation Requirements

Participants must be familiar with and abide by professional and legal confidentiality requirements regarding all client information shared in the training. Certification in EFT is offered by ICEEFT based on completion of all requirements and demonstrated competence in the model. Completion of training does not guarantee competence or certification. Enrollment in this training constitutes an agreement to hold harmless Kansas City Emotionally Focused Therapy Community and all presenters and trainers from any and all claims, actions, and judgments, including all costs of defense and attorney’s fees incurred in defending against the same. I have read and agree to follow the terms for participation.

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Confidentiality Agreement

I agree to keep confidential the personal identifying information of case material shared in the training. I agree to not record any part of this training in any format (audio, video, or visual). Personal written notes of non-confidential material are permitted.

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Fees are per segment, four segments total:

$425: Early Bird Registration (on or prior to May 9th, 2020) 

$450: Regular Registration (after May 9th, 2020)

A commitment to all four segments is required. 

To pay by check, complete this form and mail check to: 205 S 5th St, Ste 22, Leavenworth, KS 66048.  Please make check payable to "KCEFT Community".  Registration will be complete once payment has been received. 

The second payment for CS 1 & 2 is due June 21st, 2020.  Final payment for CS 3 & 4 is due July 22nd, 2020 (last day of CS 1 & 2). 

Refunds permitted up to 6 weeks before event minus a $150 administrative fee. No refunds permitted after June 6th, 2020.

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Registration Form

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Qualifications

I have the training and educational qualifications to legally practice as a professional mental health practitioner in the area I live OR I am in formal training to be a professional mental health practitioner.  I have also completed a live externship in Emotionally Focused Therapy. 

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Licensure and/or student status: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Participation Requirements

Participants must be familiar with and abide by professional and legal confidentiality requirements regarding all client information shared in the training. Certification in EFT is offered by ICEEFT based on completion of all requirements and demonstrated competence in the model. Completion of training does not guarantee competence or certification. Enrollment in this training constitutes an agreement to hold harmless Kansas City Emotionally Focused Therapy Community and all presenters and trainers from any and all claims, actions, and judgments, including all costs of defense and attorney’s fees incurred in defending against the same. I have read and agree to follow the terms for participation.

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Confidentiality Agreement

I agree to keep confidential the personal identifying information of case material shared in the training. I agree to not record any part of this training in any format (audio, video, or visual). Personal written notes of non-confidential material are permitted.

I agree. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fees are per segment, four segments total:

$425: Early Bird Registration (on or prior to May 9th, 2020) 

$450: Regular Registration (after May 9th, 2020)

A commitment to all four segments is required. 

To pay by check, complete this form and mail check to: 205 S 5th St, Ste 22, Leavenworth, KS 66048.  Please make check payable to "KCEFT Community".  Registration will be complete once payment has been received. 

The second payment for CS 1 & 2 is due June 21st, 2020.  Final payment for CS 3 & 4 is due July 22nd, 2020 (last day of CS 1 & 2). 

Refunds permitted up to 6 weeks before event minus a $150 administrative fee. No refunds permitted after June 6th, 2020.

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Registration Form

July 19-22, 2020 with Elana Katz / November 8-11, 2020 with Veronica Kallos-Lilly

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Qualifications

I have the training and educational qualifications to legally practice as a professional mental health practitioner in the area I live OR I am in formal training to be a professional mental health practitioner.  I have also completed a live externship in Emotionally Focused Therapy. 

I agree. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Licensure and/or student status: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Location and Date of Externship: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Participation Requirements

Participants must be familiar with and abide by professional and legal confidentiality requirements regarding all client information shared in the training. Certification in EFT is offered by ICEEFT based on completion of all requirements and demonstrated competence in the model. Completion of training does not guarantee competence or certification. Enrollment in this training constitutes an agreement to hold harmless Kansas City Emotionally Focused Therapy Community and all presenters and trainers from any and all claims, actions, and judgments, including all costs of defense and attorney’s fees incurred in defending against the same. I have read and agree to follow the terms for participation.

I agree. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Confidentiality Agreement

I agree to keep confidential the personal identifying information of case material shared in the training. I agree to not record any part of this training in any format (audio, video, or visual). Personal written notes of non-confidential material are permitted.

I agree. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fees are per segment, four segments total:

$425: Early Bird Registration (on or prior to May 9th, 2020) 

$450: Regular Registration (after May 9th, 2020)

A commitment to all four segments is required. 

To pay by check, complete this form and mail check to: 205 S 5th St, Ste 22, Leavenworth, KS 66048.  Please make check payable to "KCEFT Community".  Registration will be complete once payment has been received. 

The second payment for CS 1 & 2 is due June 21st, 2020.  Final payment for CS 3 & 4 is due July 22nd, 2020 (last day of CS 1 & 2). 

Refunds permitted up to 6 weeks before event minus a $150 administrative fee. No refunds permitted after June 6th, 2020.

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