Basic Mediation Registration Form

Please complete this form, check the session you want to attend, print it, and mail it (you may fax if paying with credit card) with your deposit to hold your place in the training. Payment in full is due the first day of training. Class size is limited.

Name

Institute/Company

Mailing Address

City

State/Province

Zip/Postal Code

Home Phone

Work/Cell Phone

Fax

Profession

Bar#

Fall 2009 (November 6-8 | November 13-15)

Spring 2010 (January 29-31 | February 12-14)

I wish to register for MCLE (up to 10) extra credits at $1.00 each

Check enclosed payable to UNM School of Law
Credit Card

Visa Master Card
Card Number Exp. Date

Cardholder's Signature X_________________________________

Course fee for Basic Mediation: $895.00

Mail Registration Form and Check to:
UNM Mediation Training Coordinator
UNM School of Law
1 University of New Mexico
MSC11 6070
Albuquerque, NM 87131-0001

Or FAX form and credit card information to: 505-277-7825