NATouch Application 2018
RequiredRequired Question(s)
This professional training is open to all mental health professionals, psychotherapists, psychologists, medical doctors, supervised registered interns, social workers, bodywork practitioners, nurses, and life coaches. Applications are approved on a case-by-case basis. After receiving your registration, we may call you for a short conversation. This will help to insure that our training is a good fit for your professional needs. Please note that participants in this training must be willing to touch and be touched and carry malpractice insurance. 
 
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Job Title:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Country:

Required 2.
Best way to reach you?

Email (above)
Work Phone (above)
Other  
  • Comment:

  • 500 characters left.
Required 3.
Degrees / Licenses / Certifications 
 

50 characters left.
Required 4.
Please describe any relevant psychological trainings. 
 

350 characters left.
Required 5.
Do you have training in somatic psychotherapy or touch for therapeutic purposes? 
 

350 characters left.
Required 6.
What are your areas of specialization? 
 

350 characters left.
Required 7.
Do you have training in any other bodywork or movement modality? 
 

350 characters left.
Required 8.
What is your professional practice setting? 
 

50 characters left.
Required 9.
Please tell us about your interest in the NeuroAffective Touch training and how you think it will benefit you?
 

350 characters left.
Required 10.
Do you have a mindfulness, meditation, or yoga practice? If you do. please tell us about it.
 

50 characters left.
Required 11.
How did you hear about the NeuroAffective Touch training? 
 

50 characters left.
Required 12.
Do you have a massage table that you can bring to the trainings (not required)? 
Yes
No
13.
Is there anything else you would like to tell us that you feel would help us know you better?
 

350 characters left.

REGISTRATION

Now that you have filled in your application, please "Finish" below for the registration link.

Registration: Full tuition $575 per module / Early Bird Discount $525 per module (ends Dec 12) / Five module discount $2,300
Questions? Please contact: victor@neuroaffectivetouch.com 

The NeuroAffective Touch Institute reserves the right to approve or deny any application, and/or accept or reject the participation of any person in its sole discretion and in accordance with its policies and the law.