Conflict Mediators Program
School Staff Trainings

REGISTRATION FORM

Circle one: Training 1, 2/25-26; Training 2, 3/19-20; Training 3, 4/29-30; Training 4, 5/14-15

Please type or print clearly.

NAME OF SCHOOL _____________________________________________________________________

ADDRESS ____________________________________________________________________________

__________________________________________________________ ZIP _______________________

TELEPHONE _____________________________ FAX _____________________________

TYPE OF SCHOOL/GRADES __________________________________________________

1) NAME_______________________________________________ POSITION ____________________
Person who will serve as Coordinator of the Conflict Mediators Program at the school

2) NAME_______________________________________________ POSITION ____________________

3) NAME_______________________________________________ POSITION ____________________

4) NAME_______________________________________________ POSITION ____________________

5) NAME_______________________________________________ POSITION ____________________

6) NAME_______________________________________________ POSITION ____________________

Enclosed is ___ a check, or ___ purchase order, for $200 per registrant, made payable to:

Global Learning, Inc. Total of $_________________

Global Learning, Inc., 1018 Stuyvesant Avenue, Union, NJ 07083
(908) 964-1114 FAX 964-6335
Jeffrey Brown, Executive Director Paula Gotsch, Associate Director