REGISTRATION FORM FOR MEDIATION TRAINING
 

March 2009 Class

You may either fill out the online form below or download a copy of this form to fill out and return to us.  To download a form click here:
                                               

 

 
 
Name (formal - for certificate):
Name (informal - for nametag):
Address:
City: State: Zip Code:
Phone:  Work: Fax:
Email Address:
Employer:
Position: Accommodations Required:
How did you hear about The Justice Center of Atlanta:
  Personal Referral  Email Notice  JCA Website    Other
Training Date(s) Desired:    (Click Here for Calendar)
3-day Advanced Mediation Skills, Techniques & Approaches: $725 ($720, cost for federal employees)
1/2 day, 3-hour Continuing Education course: $85
5-day Basic Mediation Skills: $1,390
5-day Divorce & Family Mediation Skills: $1,390
2-day Advanced Divorce Practicum: $500
2-day Domestic Violence: $500
3-day Mediation in Special Education: $695
2-day Interest-Based Negotiation: $795
Mentoring for Mediators: $600 (one-on-one training for GODR registered and local residents only - your cases are assigned after you enroll.)

 

Registration & Cancellation Policy - Please Read Carefully

To register for a class:
Individuals
must send a registration form with full payment by check, money order, cash, or credit card. JCA runs credit card charges for individuals 3 weeks before the class begins.
Government Employees may register with a check, credit card, or purchase order (federal form: 1556 or SF 182) - with ALL necessary signatures.  JCA runs credit card charges 1 week before the class begins (unless requested by the agency to do otherwise)

Cancellation and Refund Policy - please read carefully:
You must cancel at least 7 full business days before the training to receive a full refund.
Enrollees who cancel fewer than 7 full business days before the class must, within 6 months, register for and attend another class; otherwise all payments are forfeited to the Justice Center of Atlanta.

There is a  non-refundable no-show fee. In the case of a no-show, the class fee will not be refunded.  If an SF 182 form was issued, we will invoice the government agency the full cost of the training.

Refunds are issued to the payor of record.

I understand that I must attend the full 40-hours of the Basic Mediation Skills class to be eligible for a certificate.  I understand that my application for training at the Justice Center of Atlanta is not an application to become a mediator for the Justice Center of Atlanta.  I also understand that the completion of the training course conducted by the Justice Center of Atlanta does not necessarily qualify me to mediate for, or be accepted as, a mediator for the Justice Center of Atlanta.

Date:  Applicant Name:

I will pay via credit card
I will pay via check or cash 
I will be sending in a purchase order
 
To Pay: Contact the registrar at 404-523-3613 x236, scan and e-mail or fax payment information to 404-523-3936. Include an e-mail address for the receipt. If you pay by credit card, JCA does not run charges until a week before the class begins, unless you request otherwise.
 
If there are any questions about my application please contact the following :
Phone:  Name:                
Comments:
             

 

 

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