Confluence Center for
Mediation & Training

Mary Forst Associates

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~~ Training Registration ~~

Use this form to register for our Workshops. When we receive the form, we will put you on the class list; when we receive payment, your registration is confirmed. You have two options for paying: by mailing us a check; or at PayPal online using a credit card or other PayPal account. 1. If you pay by check, make checks payable to: Confluence Center for Mediation and Training Mary Forst Associates Please print a copy of this form and send it with the registration fee to: 15500-H NW Ferry Road Portland OR 97231-1331 2. If you wish to pay by credit card via PayPal (an easy, secure Internet-based option), you will be provided that opportunity after you submit the registration form. Course Description: Basic Plus Mediation Skills Course Description Advanced Workplace Mediation

* Please indicate which class you want to register for: Basic Plus starts June 13, 2007 $1,095      Early Registration $1,045 (paid by May 14) Workplace Mediation October 11-12, 2007 $425     Early Registration $375 (paid by Sep 12) Does this registration qualify for 10% discount (3 registrations from one organization: see Group Discount below)? Yes No Please indicate how you intend to pay: Mailed check PayPal (credit or debit account) With this form, will you be paying: Full amount Deposit Net after deposit
* Name
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* Mailing Address
* City/State/Zip
* Daytime Phone
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Other comments:  If you're registering for Workplace Mediation, please use this space to describe the basic mediation training you have taken. Thanks.
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Things you need to know Registration: A deposit of $150.00 must be received to reserve your place. Full payment is due 14 days before training begins (30 days for early registration rate). Early Registration Discount: A $50 discount is given when registration and payment are received 30 days in advance of the first day of training. Group Discount: When several people from the same organization attend together, they reinforce the learning when they return to the workplace. If three or more register from the same organization, a 10% discount will be given to the second and subsequent registrants. Cancellations: Notice of a cancellation must be received in writing. Full refund of fees will be given if cancellation is received at least 21 days in advance of the first day of training. Within 11 - 20 days, a nonrefundable amount of $150.00 will be charged. Within 10 days, we regret that no refund can be made. Substitutions will be honored at no extra charge. Credit: Basic Plus Mediation Skills is designed to exceed the Oregon Dispute Resolution Commission requirements. This training has been approved by the Oregon State Bar for 36 Continuing Legal Education credits, including 1.5 Ethics credits. NASW credit is granted for 34 contact hours (Basic Mediation) and 14 contact hours (Advanced Workplace). Schedule/Location: All sessions start promptly at 8:30 am and end at 5:00 pm. Trainings are held in comfortable, informal facilities in the Portland area. Special Needs: For needs requiring reasonable accommodation call (503) 243-2290.

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Confluence Center for Mediation & Training (503) 243-2290 1-888-462-8602 MCForst@ConfluenceCenter.com

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