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November 2022 40 Hour Mediation Training Registration Form

All participants must register for the class.  

Early bird (before September 30, 2022): $1,100.00

After October 1, 2022:  $1,250.00

November 2022 40 Hour Mediation Training Registration Form

Start

Question 1 of 6

Name, address and phone number

Question 2 of 6

Email Address

Question 3 of 6

I would like to receive continuing education credit for:

 

(Select all that apply)
A

Attorney

B

Social Work 

C

MFT

D

Psychologist  

E

Other (please contact Margaret at [email protected])

F

Not applicable

Question 4 of 6

I have read and agree with the following:

Registration includes a $200 non-refundable deposit (if class is cancelled by instructor, full refunds will be given):

A

I agree

Question 5 of 6

I have read and agree with the following: 

Cancellation Policy:  Transfer of registration to another person may be done at any time before class without a fee.  All requests for refunds must be made in writing.  Written notice of cancellation received via U.S. Mail or email postmarked by October 14, 2022 will be issued a full refund less the $200 deposit.  Refund requests made after October 14, 2022 will be treated on a case-by-case basis.   No refunds will be issued once class has started. 

A

I agree

Question 6 of 6

Rather than PayPal, I would like to pay for this class via:

A

Credit Card

B

Zelle

C

Check

D

Skip

Confirm and Submit