Name *

First Name

Last Name

Gender: *

Male

Female

Other

Prefer not to say

Phone

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Highest Level of Education Completed: *

High School Diploma/GED

Associate Degree

Bachelor's Degree

Master's Degree

Doctorate

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any previous experience in mediation or conflict resolution?

Yes

No

Consent to Training Format: Our training is done remotely and shall run from September 1st- September 19th. *

Agreed

Payment & Refund Policy *

Enrollment is confirmed only after full payment ( $ 1,200). All payments for training, certification, and materials are non-refundable, regardless of the reason for cancellation or withdrawal. Once enrolled and paid, participants are expected to complete the course. No refunds will be issued for cancellations or non-completion. TRANSFER ENROLLMENT: Enrollment transfers to future course dates may be requested and are subject to approval and possible fees. EXCEPTION: (a) Medical Emergencies: Participants may request a deferment with valid medical documentation. Approval is at our discretion; (b) Program Cancellation: Participants may transfer to a future date if we cancel a course. REQUEST PROCESS: Exception requests must be submitted in writing with documentation within 10 business days of the relevant event. We will respond within 15 business days. ACKNOWLEDGEMENT: By enrolling, participants agree to this non-refundable policy and accept full responsibility for understanding the terms before payment.

Agreed

I agree to all terms and conditions of the Mediation Skill Training and Certification Program linked in this form. *

I agree

Date:

MM

DD

YYYY