Trademark and Copyright Request Form

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Contact Information

First Name

Last Name

This should be the email on file with SEI.

Phone

Please enter a valid phone number in the international format.

Address

Street Address

City

State/Province

Zip Code/Postal Code

Country

Information

Are you currently or have you been a student in Somatic Experiencing® International trainings?

YesNo

If you have been a student, what’s the highest level of training that you completed? (i.e. Intermediate II, Advanced I)?

Please select your intended use for copywritten materials. Select all that apply.

Photo/illustrationArticleWeb contentPublicationEvent/courseOther

You selected Other, please elaborate.

Please provide detailed description of your proposed use of our materials.

(What do you wish to use our materials to do?)

Additional Information

Please complete the following information:

Name of event/course/material:

Date(s) of event

ex: 1/11/23 - 2/11/23

Location of event

Number of expected attendees

Cost paid by attendees, if any

write in N/A if this doesn't apply

Are you being compensated for this event/course/material?

YesNo

Which specific SE Materials you’d like to use?

(i.e.- PowerPoint presentation, this or that diagram from Manuals, etc.);

Document Upload

#1 Please provide all materials/images that you plan to use

#2 Please provide all materials/images that you plan to use

#3 Please provide all materials/images that you plan to use

#4 Please provide all materials/images that you plan to use

#5 Please provide all materials/images that you plan to use