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Name
(informal - for nametag): |
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Address: |
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Zip Code: |
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Phone: |
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Work: |
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Fax: |
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Email Address: |
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Employer: |
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Position: |
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Accommodations Required: |
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How did you hear about The
Justice Center of Atlanta: |
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Personal Referral
Email Notice
JCA Website
Other |
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Training Date(s) Desired: |
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3-day
Advanced Mediation Skills, Techniques & Approaches: $695 |
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GSA
ONLY 3-Day Advanced Mediation Skills, Techniques &
Approaches $693 |
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5-day
Basic Mediation Skills: $1,390 |
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3-day
Mediation in Special Education: $695 |
Mentoring
for Mediators: $400
(for local residents and GODR registered mediators only)
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Registration & Cancellation
Policy - Please Read Carefully |
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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. |
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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. |
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Date:
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Applicant Name:
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I will pay via credit card |
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I will pay via check or cash
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I will be sending in a purchase
order |
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If there are any questions about
my application please contact the following : |
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Phone:
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Name:
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Comments:
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