Community Mediation Services

59 E 11th Ave, Suite 100
Eugene, OR 97401
Phone: 541-344-5366

Family Mediation Training Registration Form

WHO:   Community Mediation Services presents Jim Melamed, trainer

WHEN:   June 1-4, 8:00am-7:00pm (One hour lunch)

WHERE:   Spencer Butte Yurt, Eugene, Oregon (Specifics will be emailed to all paid registrants before the date)

COST:  $750.00.  Price includes all materials, continental breakfast and snacks throughout the day.  You may bring your lunch, or eat out.

CRES Students: UO Conflict & Dispute Resolution Students have been offered a discount; to pay contact  Chip Coker at 541-344-5366.

LIMITED SEATING:  You must pre-register by May 21. No walk-ins will be permitted. 

PAYMENT METHODS: You may pay by check or PayPal. To pay by PayPal complete this registration form by selecting Submit Now and you will be offered a link to the online payment form. To pay by check, send to: 

Community Mediation Services
Family Mediation Training Registration
59 E. 11th Avenue, Suite 100
Eugene, OR 97401

CANCELLATIONS:  Fifty percent refund if you cancel after May 21, but on or before May 26.  NO REFUND if you cancel after May 26, or fail to be present on the day of the seminar.

PRIVACY POLICY:  Your privacy is important to us.  We will never sell or otherwise provide your contact information to any non-related third party, without your consent.

Name
first last
Title
Company
Address
street line 1
street line 2
, city, state/prov zip
Email
Phone
Fax
Are you a member of a profession that requires continuing education?
Yes
No
If your answer to the previous question was yes, please indicate your profession here:
Please tell us how you heard about this training:
How will you use your new skills?
Volunteer or staff at a CDRC
Court mediator (staff)
Private Practice
List the date of your basic mediation training:
Please identify the agency or trainer for your basic mediation training:
How many cases (any type) have you mediated?
0-10
11-50
Over 50

Note: Please do not include any URLs in form.

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