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REGISTRATION FORM - ADR MEDIATION AND NEGOTIATION

   Please enroll me in the following ADR Mediation and Negotiation Skills Program:

Date of program__________________ City ___________________

Level 1 only

Level 2 only*

Full program

   To register, please enclose a cheque made out to Dr. Barbara Landau. If you prefer to pay by credit card, please indicate account #, expiry date and signature in the space provided.
Tax receipts will be issued.
Please print clearly and keep a copy for your records.

(Please choose the appropriate course below)

Level 1 only $942.00 (including GST)

Level 2 only $1,177.00 (including GST)
     *I have previously completed Level 1

Levels 1 & 2 (6 day program) $2119.00 (including GST)

   * 5% discount for payment in full received 30 days prior to the course start date.

   * Refunds less $160.00 administration fee for written notice of withdrawal up to 14 days prior to course start date.

   Name : ________________________________ Occupation: _______________________________

   Address:__________________________________________________________________________

   City: _______________________ Province:_________________ Postal: _____________________

   Home Phone: __________________ Bus. Phone:__________________Fax: _________________



   If payment by VISA Mastercard, please complete:

   Account # _________________________________ Expiry Date: _____/_____/_____ (mm/dd/yy)

   Signature: _____________________________________ Date: ____________________________



   Mail completed form and cheque to:

Dr. Barbara Landau
76 Truman Road
Toronto, Ontario M2L 2L6
Canada


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