Family Mediation Registration Form

Please complete this form, 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#

January 23-25, 2009 | February 6-8, 2009

Course fee for Family Mediation: $895.00

Check enclosed payable to UNM School of Law
Credit Card

Visa Master Card
Card Number Exp. Date

Cardholder's Signature X_________________________________

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