Training Form – Brittany Bagy, LPC

Name*

Email*

Cell Phone Number*

Address*

City*

State*

Zip Code*

Please indicate the Trainers and Date for which you completed the Brainspotting Phase I training?*

Please list all Brainspotting trainings that you have completed.

Date*

Profession*

Are you Pursuing CE?*

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I confirm I plan to attend this event:*

In-Person in St. Louis, MO

License Type*

License Number

I understand and acknowledge that I have reviewed the Refund Policy .*

I agree

What are your goals, hopes, and/or intentions for taking this training?

Photo (Optional)

How did you hear about this event?

I understand and acknowledge that all efforts will be made to hold this training in-person in St. Louis, MO if the minimum number of in-person participants are registered to attend. If unexpected circumstances arise or the minimum number of in-person participants are not registered, you will be notified 60 days in advance that the training that it will be completely online.*

I agree.

Address

Phone

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Address

10820 Sunset Office Drive,
Suite 204, St. Louis, MO

Phone

314-492-5344

Brittany Bagy, LPC

Brittany Bagy, LPC

Brain Integration with Self-Compassion & Brainspotting

Clinician Training Registration

Address

Phone

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Address

Phone

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