REGISTRATION FORM FOR MEDIATION TRAINING
 

April 2008 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:
3-day Advanced Mediation Skills, Techniques & Approaches: $695
GSA ONLY  3-Day Advanced Mediation Skills, Techniques & Approaches $693
5-day Basic Mediation Skills: $1,390
3-day Mediation in Special Education: $695
Mentoring for Mediators: $400 (for local residents and GODR registered mediators only)
 
Registration & Cancellation Policy - Please Read Carefully

To register for a class, JCA must receive the registration form a) with full payment by check or credit card number, b) via this online form followed by check or credit card payment, or c) with a completed 1556 form.  Enrollees who cancel prior to the 1st day of class must, within 6 months, either a) register for and attend another class or b) request a refund in writing otherwise all payments will be forfeited to the Justice Center of Atlanta. 

There is a $300 non-refundable no-show fee.  In the case of a no-show, the $300 fee will either be charged to the credit card, or a refund check will be issued minus the $300 fee.  If a 1556 form was issued, we will invoice the government agency the $300 no-show fee. 

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
If there are any questions about my application please contact the following :
Phone:  Name:                
Comments:
             

 

 

   © 2008 Justice Center of Atlanta