Registration for Philadelphia, PA Workshop

Registration Form

Hakomi Mindful Somatic Psychotherapy: An Experiential Introduction

with Melissa Grace, M.A., Certified Hakomi Trainer
​​
October 5-6 in Philadelphia, PA

*(Required)

*Your Name

Degree or Credentials (Optional)

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*Are you a student?
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*How did you hear about the workshop? (Check one or more)
Hakomi Institute WebsiteHakomi EmailPsychotherapy Networker: (Website, print magazine or conference?)Friend/Referral (Who may we thank for the referral?)
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*Are you taking the workshop as (check one or more):
A prerequisite for the Hakomi Therapy TrainingA therapist or practitioner interested in learning more about HakomiFor personal growthFor other reasons (describe):

If you are seeking CEs for this workshop, please indicate:
PsychologistSocial workerMFTProfessional counselorNational Certified Counselor (NCC) seeking NBCC CEs

If seeking CEs for state license, which state is your license in?: