Registration for Princeton, NJ

Registration Form

Hakomi Mindful Somatic Psychotherapy: An Experiential Introduction

with Melissa Grace, M.A., Certified Hakomi Trainer
April 27-28 in New York City


*Your Name

Degree or Credentials (Optional)






Cell phone:

*Your Email



*Are you a student?

If student, name of school and program:

*How did you hear about the workshop? (Check one or more)
Hakomi Institute WebsiteHakomi EmailPsychotherapy Networker: (Website, print magazine or conference?)BBMHG, NYPSA, UWS, GSAPP, Hunter or other NY listserveFriend/Referral (Who may we thank for the referral?)

*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?: