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Intergrating substance with skill

AA White Dispute Resolution Center
Registration Form

Note:   Payment in full is required for the Commercial Arbitration Training, and either a $300 deposit or payment in full, must accompany the registration form for the Basic Mediation Training in order to reserve your place in these courses. Friday Mediation Series trainings are $70, no deposit is required. Cancellations must be received – in writing – 5 business days prior to the start of the program in order to receive a refund.  There will be a $25 processing fee for all cancellations.

Application Information

(This form cannot be submitted or printed unless all the requested information has been entered.)
 
Program title

40-Hour Basic Mediation Training

Commercial Arbitration Training (Domestic and International)

Friday Mediation Series
Program start date
Please check one Mr.  Ms.  Mrs.  Dr.
Last name
First Name/MI
Informal Name
Profession
Title
Employer
Mail address 1
Mail address 2
City
State/Zip  
Bus Telephone (xxx-xxx-xxxx)
Bus Fax (xxx-xxx-xxxx)
Email address
Home Telephone (xxx-xxx-xxxx)
Method of Payment:
Check Money Order Purchase Order Credit Card
Do you have any special needs?