Event Registration Form

Step 1: Enter the name of the person for the registration.
First Name*
Last Name*
Phone*
Email*
Occupation
Employer
Comments or Questions
 
Step 2: Enter the name of the person you are registering.
NOTE: The name you enter beblow is the name that will appear on their certificate of completion.
Name*
Email
Cell/Mobile (used during training)
Step 3: Person's address where materials will be shipped (if known).
Address
Address 2
City
State
Zip Code
 
Step 4: Enter your payment information below.
Event Name: January 20-Hour Advanced Mediation & Conflict Transformation Skills
Event Date: January 29, 2025 @ 5:00 pm - January 31, 2025 @ 4:00 pm
Event Price: $995
Payment Type By Card By Check
Card Holder Name*
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Card Expiration Date*    
Card Verification Number*
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Address1*
Address2
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Zip Code*
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Cancellation Policy

This course is customized to 20 registrants, and it fills up quickly. We will add you to a waiting list once the course is filled on a first come, first served basis, but we rarely have cancellations. Our cancellation policy is a full refund if cancellation is at least 30 days from start date, and a half price refund if cancellation is 21-29 days from start date. No refunds thereafter. Customized materials will be sent to you via email and in the mail prior to training. We look forward to having you part of our network of transformative mediators and professionals practicing from a relational framework making a difference in the world!