Restorative Justice Workshop

Registration Form

Restorative Justice Workshop

 

Name: _______________________________________________

Organization or Referral: ________________________________

Occupation: ___________________________________________

Address: _____________________________________________
____________________________________________________
____________________________________________________

Phone: (      ) __________________________________

Fax:     (      ) __________________________________

Email: _______________________________________

Special Needs: ________________________________

 

NEW!! Online registration now available: www.cjadurham.com

 

Mail or fax your completed registration to:

 

Attn: Restorative Justice Coordinator

Community Justice Alternatives of Durham Region

Durham Community Mediation Program

700 Finley Avenue, Unit #4

Ajax, ON

L1S 3Z2

 

Tel:  905 683-8615 ext. 225     Fax:  905 426-2139