Registration Form for Certificate Program for Mediation
Registration Form for Certificate Program for Mediation
June 15-16, August 3-4, and September 14-15, 2007 Cortina Inn & Resort, Killington, Vermont
Please print this page, fill out the Registration Form, and Fax it to: 802 457-1501 OR Mail it to: Woodstock Institute for Negotiation, Pomfret Stage Road-Drawer 29, Woodstock, Vermont 05091
You can also register over the phone by calling 800 457-3211
Name: _____________________________________________ I go by (for Name Tag): __________________
Company/Organization: ________________________________________ Position: ____________________
Street Address: ______________________________________________________________________________
______________________________________________________________________________
City: _____________________________________________ State: _______________ ZIP: ______________
Work Phone: ____ ___________ Home Phone: ____ ___________ Fax: ____ ___________
E-Mail Address: ____________________________________________________________________
Fees:
___ Please Register me for the Certificate Program for Mediation $ 2,295.00
Payment Plan:
___ Payment Plan One: Payment of the full amount of the Training
less a $100.00 reduction or $2,195.00.
Full payment due on or before April 27, 2007 $2,195.00 $ _________
___ Payment Plan Two: Payment of the full amount of the Training
Full payment due on or before May 25, 2007 $2,295.00 $ _________
___ Payment Plan Three: Payment of $765.00 for each 2-day Session
with each payment payable at least 21 days prior to each session
and with a $50.00 late payment fee for any payment not received
by WIN by each due date. (Total Payments = $2,295.00)
First Payment due on or before May 25, 2007 $ 795.00 $ _________
___ Payment Plan Four: Payment of an initial payment of $1,095.00
and then payment of the balance of $1,200.00 by 12 monthly payments
of $100.00 plus interest at 1% per month on the outstanding balance
[ANNUAL PERCENTAGE RATE = TWELVE PERCENT (12%)] with each payment
due on the 25th of each month beginning on June 25, 2007 and with a
20.00 late payment fee for any payment not received by WIN on or
before a payment date. (Total payments = $2,373.00 if all payments
are made on time)
Initial Payment due on or before May 25, 2007 $1,095.00 $ _________
Late Payment fee if initial payment Recieved by WIN after May 25, 2007 $ 100.00 $ _________
Total Amount Due $__________
Payment:
___ Payment Enclosed ___ Payment will be mailed
(Please make check Payable to "Woodstock Institute for Negotiation")
Please Charge to: __ VISA __ MasterCard __ American Express __ Diners Club
Card Number: _______________________________________ Expires: ___ _____
Name as it appears on card: _____________________________________________
Signature: ___________________________________
If you are electing Payment Plan Three or Payment Plan Four, please sign and date to indicate
your agreement to the payments due in the future and to the late penalty fees:
Signature: ___________________________________ Date: _____________
Policies of the Woodstock Institute for Negotiation for this Program:
Cancellation Policy: Up to 21 days prior to the first session of the Certificate Program for Mediation (May 25, 2007),
you are allowed to cancel your registration entitling you to a refund of your payment less a cancellation fee of $100.00.
No refunds will be given after this time and all payments under Payment Plans 2 and 3 will be due and payable as set forth above,
but you will be allowed to send a substitute person to the Certificate Program for Mediation you registered for OR you or your
substitute may attend a future Certificate Program for Mediation for a re-registration fee of $100.00.
If you are not able to print this Registration form, please send us an e-mail or call us and we will fax or mail the Registration Form to you.
If you have any questions, please call us Toll Free at: 800 457-3211
March 30, 2007
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