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Course Registration TSC Rule 31 Mediator Training

CONSENSUS
Conflict Management & Mediation Services, LLC
Nashville, Tennessee

Contact Us:
(615) 346-9642 Ext. 10
Training@DontLitigate.com
www.DontLitigate.com

Your Name (Attendee): * First Last
Please enter the FIRST and LAST name of the person that will be attending this course.
Your Mailing Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please provide the address where you would like to receive any relevant snail mail from our organization.
Your Occupation: *

Please select your primary occupation that best describes what you are doing in your current or most recent professional career.
Your Work Telephone: * ### - ### - ####
Please provide us with your PRIMARY telephone contact number - in case we need to ask questions about your registration.
Your Cell Number: * ### - ### - ####
Your Email Address: *

Please provide us with your primary/desired email address for course related correspondence and notifications.
Which Course are You Registering For?: *
$1,350.00 = 46 Hour TSC Rule 31 Family Mediator Training (Monday through Saturday) $1,100.00 = 40 Hour TSC Rule 31 General Civil Mediator Training (Monday through Friday) $ 750.00 = 30 Hour TSC Rule 31 Civil to Family Mediator Crossover Training (Tuesday through Friday) $ 450.00 = 16 Hour TSC Rule 31 Family to Civil Mediator Training (Tuesday & Wednesday) $ 450.00 = 16 Hour TSC Rule 31 Family to Civil Mediator Training (Friday & Saturday) $ 400.00 = 12 Hour TSC Rule 31 Domestic Violence Training for Family Mediators (TBD)

Since each course is separate from the others and has specific course identifiers & dates, you may register for ONLY one course at a time.

ATTENTION ATTORNEYS: This course fee does NOT include the reporting fee for CLE credit hours. All Courses listed here are approved for CLE credit by the Tennessee Commission for Continuing Legal Education and Specialization (hour-for-hour). Please ADD this CLE reporting fee ($2.00 per credit) to your total payment.
Please Enter the "Beginning Date" of the Course
You Have Selected Above: * MM / DD / YYYY
This is the very first day of the course date you wish to attend. If you do not know this date please contact us at training@dontlitigate.com.
Are You Requesting CLE Credit For This Training?: *
I am NOT an Attorney YES - I am requesting CLE Credit NO - I am NOT requesting CLE Credit
If YES, Enter Your BAR / BPR # Here:

TN BAR/BPR #'s are 6 digits. Please provide all leading and following zeros (eg 012340).
If YES, How Many CLE Hours Are You Requesting?
Total CLE Reporting Fee ($2.00 per CLE Hour Reported): $ Dollars . Cents
ATTORNEYS ONLY:
The Tennessee CLE Commission charges $2.00 per CLE credit hour for reporting. Please enter the Total CLE Reporting Fee here AND add this fee to your "Total Payment Being Submitted" below. If you are requesting CLE reporting for other States, please provide those details in the "Comments" Box below.
Total Payment Being Submitted: * $ Dollars . Cents
This amount should be equal to the Course Fee plus CLE Fee (Attorneys only).
How Would You Like To Pay?: *
Business Check Personal Check Money Order / Cashier's Check Credit Card

As a convenience to our customers, we gladly accept business and personal checks. In the event a check is returned for any reason, the Payor will be assessed a $50.00 Returned Check Fee.
Type of Credit Card:

By sumitting this form, the cardholder named herein understands that his/her credit card will be charged for the "Total Payment Being Submitted" amount indicated below and further accepts all responsibility for payment of these fees.
Name Appearing on the Credit Card:
Your Credit Card Number:

If paying with a major Credit Card (VISA, MasterCard, AMEX or Discover only), please enter the card number separating the number with dashes (-) where appropriate.
Your Credit Card's Expiration Date (MM/YYYY):
Your Credit Card Security Value (CSV) Number:
(on BACK of card at end of signature box)
Your Credit Card Billing Address: (if different from above)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

If your Credit Card billing address is different from the address provided above, please provide that complete address here.
COMMENTS:
(also provide your business or personal check information)
(see instructions to the right) *

Please provide the followiing information for your Business or Personal Check:

1. Check Number

2. Payor Name (please make your check out and mail as follows):

Consensus CM&MS, LLC
P.O. Box 198585
Nashville, TN 37219-8585

NOTE: If paying with a Major Credit Card, please type "Credit Card" in this box.
Registration for all training provided by Consensus is confirmed on a first-come, first-served basis and requires receipt (by Consensus) of payment in-full for the training. All transactions are final. Registrants may postpone their confirmed training to a future date (within one year of this transaction). Consensus issues no refunds.
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