Solana Beach Group Supervision Registration

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Registration Form
Solana Beach, CA Group Supervision
in Emotionally Focused Therapy

               
          Solana Beach group supervision runs on a 6 month cycle.
 

 

Cost: $350.00 for 10 hours.  

 

Completing this form indicates an agreement to attend all 5 group supervision sessions and will reserve your place in this sesison if space is available. 

After you complete this form you will be direted to a "Pay Now" page.  If you would prefer to pay by check please indicate so in the "comments" section on this form.

For questions call 619-694-6433 or email Dr. Jorgensen at dr.rebecca.jorgensen@gmail.com. She will gladly assist you.
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
State:
Zip Code: (5 digits)
Daytime Phone:
Evening Phone:
Email:
Please indicate the EFT Training you have
completed to date: 		  Read the Manual
  Completed the Workbook
  Externship
  Advanced Externship
  Core Skills Training
  Previous Supervision
Location of Externship Attended:
Date of Externship Attendance: Month/Year:
Comments:

Copyright . Rebecca Jorgensen. All rights reserved.
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