Durham Community Mediation Program

Registration Form

Mediation Training Program

 

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: Mediation Training 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

Please select the dates you are registering for:

 

Cost: $450.00, training costs include instruction (21hrs), materials, as well as morning and daytime refreshments.

 

Method of Payment: Cheque: ______Cash:______ (Please check one)

Cheque payable to: Community Justice Alternatives

 

_____ Basic Mediation Skills Training, March 28, 29, 30, 2008

_____ Advance Mediation Skills Training, June 20, 21, 22, 2008*

_____ Basic Mediation Skills Training, November 7, 8, 9, 2008  

*Please note, Basic Mediation Skills Training must be completed to be eligible for the Advanced Mediation Skills Training course.