Registration/Notification List for MMS Mediation Training

What does it take to become a mediator?  See our Certification and Career FAQ

 

You can register for our Mediation Training Programs by filling out the form below. 

IF YOU CANNOT USE THE ONLINE APPLICATION, BELOW click this link

for a printable  Brochure and application in Adobe Acrobat (pdf.) format

 

Submitting the completed electronic form below will hold your place for two weeks, 

pending receipt of your $100 deposit payment.

 

If you do not receive acknowledgement of your registration within 2 business days, 

please call (617) 241-0300  to confirm that your registration has been received.

 

 

Please provide the following information

 * indicates required responses.

 
* Activity (choose one):   
Enroll me in the Jun 5 - Jun 16, 2012 TRAINING
Enroll me in the Oct 17 - Oct 27, 2012
Enroll me in the Jan 29 - Feb 9, 2013
Add me to your NOTIFICATION LIST  for future trainings

* First Name

* Last Name

Profession and Organization

Street Address

Street Address 2

City

State

Zip

 

Eve. Phone

Day Phone

* Email

Fax

 

Professional Continuing Education credits for Social Workers, Educators, or Mental Health Counselors:  Choose one: I am seeking...

  Social Worker CEUs  
  Educator PDPs  
  Licensed Mental Health Counselor CE 
  I am not seeking CEU/PDPs

 

How did you learn about MMS' training programs?  

 

Offer Code (if any) from your brochure or other information source.

Please Provide Details (publication name, person or org. who made referral, etc.)

Questions Comments

If you do not receive acknowledgement of your registration wthin 2 business days, 

please call (617) 241-0300 to confirm receipt of your registration.

This application is not complete until your non-refundable $100 deposit is received.  For the early-bird discount, the full tuition is due by the early-bird deadline.