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Domestic Mediation Practicum Registration Form
Please use this form to register for the Domestic Meditation Practicum.
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* Indicates required question
Complete Name (As is will appear on the mediation training certificate)
*
Your answer
Email Address
*
Your answer
Address (Street, City, and Zip Code)
Your answer
Telephone Number (123) 456-7890
Your answer
Which training dates are you registering for?
*
March 27-28, 2020 (Athens, GA)
September 10-11, 2020 (Athens, GA)
How did you learn about our mediation training?
*
Georgia Office of Dispute Resolution
ADR Website
Social Media (Facebook, Social Media, Instagram, Twitter, LinkedIn)
Advertising
Training or Speaking Engagement
Personal Referral
Attended another ADR training
If you selected "Personal Referral" please let us know who we should thank:
Your answer
Which of the categories below best describe your profession?
*
Judge/Hearing Officer
Attorney
Mental Health Professional
Educator
Law Enforcement
Human Resource Professional
Entrepreneur
Retired
Other:
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