Class size is limited, so please register early.
Special payment arrangements are available, including discounted tuition rates
for students and nonprofits.
To register, print out this form
and either mail it with payment to the address below
or fax it in with the necessary credit card information.
To view courses currently scheduled, please see our Current Offerings page.
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| Title/Occupation |
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| Company/Organization |
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| Address |
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| Work Tel |
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Home Tel |
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| Work Fax |
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Home Fax |
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| Cell Phone |
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E-mail |
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Please indicate the program, the number of people attending, and the program dates.
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Course Title
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Course Dates
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Tuition
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Last Day to Register
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____ Comprehensive Mediation Training—both Level I and Level II (for a 40-hour Certificate of Completion)
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May 8, 9,
14, 15 & 16, 2009
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____ $1,250
____ $1,150 by 3/31/09
____ $1,000 by 2/15/09
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May 1, 2009
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____ Level I only—Fundamentals course (two days)
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____ $500
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May 1, 2009
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____ Level II only—Completion course (three days)
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____ $750
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____ Advanced Mediation Training |
October 23, 24
& 25, 2008
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____ $750 |
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Payment Options
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I am paying by CHECK (made payable to "Professional Mediation Associates").
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____
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I am paying by CREDIT CARD. My
____ Visa
____ MasterCard
number is ________________________________, and the expiration date is __________.
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____
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If the name and address shown for my course registration do not match what is shown on my credit card billings, the name/address associated with my credit card is/are:
_____________________________________________________________________________
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____
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My authorization signature: x__________________________________________________
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Cancellations
There is a nonrefundable cancellation fee of $150,
or you may transfer to another course within 12 months.
We reserve the right to cancel a course at any time for a full refund of your payment.
We cannot be responsible for nonrefundable travel and accommodation arrangements.
Mail or fax completed form, with payment, to:
Professional Mediation Associates
700 Larkspur Landing Circle, Suite 199
Larkspur, CA 94939
(415) 454-4478 (tel)
(415) 464-0508 (fax)
t.carey@ix.netcom.com
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