Name:                                                                                     

Organization:                                                                            

Mailing Address:                                                                                                

Phone:                                                  

Email:                                                  

ADRNC Member?  __ Yes     __ No         ACR Member?  __ Yes     __ No

Are you a student?  __ Yes     __ No          
Name of school:                                      

Enclosed conference fees:

__ $95 ADRNC/ACR Member

__ $130 Non-Member

__ $65  Student/Volunteer (you never mediate for pay)/Hardship

__ $40 MCLE Credit* – 4 1/2 hours

__ $40 BBS Credit which applies to MFT & LCSW** – 4.75 hours

__ $20 – Late Registration: after 5 pm April 17, 2005 and thereafter

Membership Dues

Dues for new members signing up while registering for the conference (applies for membership from March 2006 through June 30, 2007).

__ $70 Regular Member

__ $30 Student/Volunteer/Hardship

__ $175 Organization

If you would like to be a Sponsor please contact us. Sponsor rates from $300 - $1000+ ADRNC is a 501(c)(3) organization; your sponsorship may be tax deductible.

$___________ Total amount enclosed

Registration Deadline

Pre-registration is recommended, as space is limited and last year’s conference sold out in advance of the event. On-site registration is only on a space-available basis, and is not recommended. All attendees should check the ADRNC website at www.adrnc.net the day prior to the event for updated information.

Concurrent Sessions

Please select one morning and one of each  session group to attend:

Session Group One (Select one):

__ Session 1A: “Mediating Inside the Institution” with Ellen Beilock & Samuel Schindler

__ Session 1B: “What Would Gandhi Do? A Lesson In Applied Spirituality” with Eileen Barker

__ Session 1C: “Mediation for the Leaders of Tomorrow: The College Students of Today” with Thom Massey

Session Group Two (Select one):

__ Session 2A:  “Non-Verbal Commumnication in Mediation” with John Ford

__ Session 2B:  “Exploring the Enneagram: Seeing Into the Heart of Conflict” with Susie Herrick

__ Session 2C: “Transformative Mediation: Purpose Drives Practice” with Lou Ann Lucke

Do you plan to attend the “Meet the Speakers” Reception from 4:15 – 5:00 p.m.?

Yes __         No  __ 

Do you require a vegetarian meal?

Yes  __         No  __ 

Building Accessibility

All buildings and restrooms are wheelchair accessible. Please advise of any other special needs below.

Continuing Education Credit

*ADRNC is a State Bar of California approved MCLE provider (#12616).
**Course meets the qualifications for 4.75 hours of continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences. (#PCE 3301).

Refund Policy

Refunds are provided at the discretion of ADRNC.

For Registration by Mail:

Make you check payable to ADRNC and mail with your registration form to:

        ADRNC

        601 Van Ness Avenue #E3-102

        San Francisco, CA 94102-6300                      

For additional information please contact:

Stacy Waters, Administrator
Phone (650) 745-3842 | Email adr@adrnc.net 

Conference-at-a-Glance | Keynote | Session 1A | Session 1B | Session 1C | Session 2A | Session 2B | Session 2C | Registration |  Directions and Parking