Community Mediation Skills course 2014

Registration form

Thank you for your interest in registering for the Mediation Skills course from 7th November until 1st December 2014.

Please complete the form below with your personal details and press submit.

Please note that places are limited and registering at this stage does not guarantee your place. You will be sent confirmation of your place in due course.

Question Title

Your details

First name

Surname

Job title / volunteer

Organisation

Email:

Telephone:

Address:

Question Title

Is your organisation,

A community organisation

A local voluntary organisation

A national third sector organisation

Local statutory organisation (eg local authority, health board, CHP)

A national public sector organisation

Other (please specify)

Question Title

Your dietary requirements

Vegetarian

Vegan

Dairy free

Gluten/ Wheat free

Nut allergy

Other (please specify)

Question Title

Please specify if you have any access, hearing or visual requirements.

Question Title

Thank you. Please note that places are limited. We ask therefore that if for some reason you are no longer able to attend, you notify us so that we can re-allocate your place or change catering requirements. Failure to attend without notification may result in a charge to cover costs. Please state that you have read and understood this.

I have read and understood the above statement.