Training Registration Form

Name:

Address, City, Zip

Firm of Organization:

Title:

Work Phone Number:

Home Phone Number:

Fax number:

E-mail:

Educational Background:

Previous Mediation/Conflict Resolution Training:

Work Experience:

What is your goal for taking this training:

If that goal is to mediate are you more interested in mediating disputes in;²H

family law
commercial
other

How did you hear about this training?

Will you need hotel accommodations to attend this seminar?‹

Yes
No

If yes, please contact us no later than two weeks prior to the training.

Verification (to make sure you're human)

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Complete Training February 29 - March 2, 7-9, 2012
$1,295 if received 3 weeks prior; $1,425 thereafter

Basic Training February 29 - March 2, 2012
$695 if received 3 weeks prior; $795 thereafter

Wednesdays 1:00 - 6:00 p.m. Thursdays and Fridays 9:00 a.m. - 5:00 p.m.

Best Western Corte Madera Inn, Corte Madera, CA

Note: Course begins promptly at 1:00 p.m. on February 29th