ࡱ> %` d:bjbj"x"x -D@@2 DDDDDDDzRRRRn| ! !!!!!!!$#hF&Z;!QD;!DD!]]].DD!]!]]DD] A^B)Rj]!0!]&G&]&D]$h^J]<;!;!G!   DR   RXlzDDDDDD  Canadian International Institute of Applied Negotiation Registration Form ADR Certificate Program & Modules I, II, and III Register today: (1) Online; (2) By Mail; (3) By Fax; or (4) By Telephone Please address all my correspondence to my Home or Office as follows: NAME (Please Print) (As it will appear on certificates) TITLE: SECTION: COMPANY/DEPT: MAILING ADDRESS: POSTAL CITY: PROVINCE: CODE: TEL HOME: TEL WORK: FAX: EMAIL: How did you hear about our courses? Have you taken CIIAN courses before? YES NO Do you have any other non-CIIAN training in ADR, NEGOTIATION OR MEDIATION? YES NO If yes, please indicate where: Registration Fee: Your registration fee covers the selected module and all course materials. Corporate Discount Rate: A $50.00 discount per person is available when 3 or more people attend the same course from the same Organization. Cancellation Policy: A cancellation made later than one week prior to a course will be subject to 50% of the course fee. Cancellations made earlier than one week prior to a course will be subject to a $75.00 Administration Fee. PAYMENT OF REGISTRATION FEESOTTAWA COURSE FEESSELECTION (please indicate date and module choice) Module 1 $1,800.00 + $90.00 GST = $1,890.00 Dates: Monday February 23 - Thursday Feb 26, 2009 Tuesday August 18 - Friday Aug 21, 2009Module 2 $1,800.00 + $90.00 GST = $1,890.00Dates: Monday March 23 - Thursday Mar 26, 2009 Monday August 24 - Thursday Aug 27, 2009Module 3 $1,950.00 + $97.50.00 GST = $2047.50Dates: Monday, Monday October 19 - Thursday 22, 2008 Monday August 19 - Thursday Aug 22, 2009Special Programs Priced accordingly*Modules I & II: Completion of both Modules has been accepted as an Approved Mediation course by the ADR Institute of Ontario Inc. All courses are approved for Federal Income Tax Deduction. Your paid invoice is your receipt. Payment Method q Please invoice my employer. Billing information as follows:Company:Attention/Reference:Address:City/Province:Postal Code:q My cheque or money order is attached (made payable to CIIAN)q Please bill by VISA or MasterCard (if registering by mail or fax). Information below. 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For your security, do not provide credit card information online.Cardholder Name:Account Number:Expiry Date:Cardholder Signature:If Employer is paying tuition, does the employer wish a tax receipt to be issued? q YES q NO (Please Note: If this question is left blank or answered  NO , no tax receipt will be issued)Name or Organization to which the tax receipt is to be issued. (Please Note: if the Employer is paying the cost of tuition, the receipt will be issued in Employer s name only upon request by the Employer): Registration closes two weeks prior to each course. Early registration will help ensure a place. Please return this completed form with payment to: CIIAN, 320 Laurier Avenue East, Ottawa, ON K1N 6P6 55525456585X5Z5g]kdl $$IfFv"| !Z:    44  a$If5kd $$Ifv!@"44  aZ5\5^5x5z5|5~55?]kd $$IfFv"| !Z:    44  a$If]kd $$IfFv"| !Z:    44  a555l6*7,788i5kd $$Ifv!@"44  a[kdX $$IfFv"| !Z:    44  a$If8899`:b:d:5kd $$Ifv!@"44  a $$Ifa$$If5kdP $$Ifv!@"44  a+;0/ =!"#$% `$$Ifg!vh5O"#vO":V ,5O"/ 4  aq`$$Ifm!vh5I"#vI":V p,5I"/ 4  aw$$Ifm!vh55+#v#v+:V ^,55+/ / / 4  aw$$Ifm!vh5;55+#v;#v#v+:V ^,5;55+/ / / 4  aw$$Ifm!vh5;55+#v;#v#v+:V ^,5;55+/ / / 4  aw$$Ifm!vh5;55+#v;#v#v+:V #,5;55+/ / / 4  aw$$Ifm!vh5;55+#v;#v#v+:V #,5;55+/ / / 4  aw$$Ifm!vh55+#v#v+:V ^,55+/ / / 4  aw\$$Ifm!vh5I"#vI":V ,5I"/  4  aw`$$Ifm!vh5I"#vI":V ,5I"/ 4  awV$$Ifv!vh5@"#v@":V 5@"/ 4  aV$$Ifv!vh5@"#v@":V 5@"/ 4  a$$Ifv!vh55j5*#v#vj#v*:V 55j5*/ / / 4  a$$Ifv!vh55j5*#v#vj#v*:V 55j5*/ / / 4  a$$Ifv!vh55j5*#v#vj#v*:V 55j5*/ / / 4  a$$Ifv!vh55j5 5n5 #v#vj#v #vn#v :V 55j5 5n5 / / / 4  aV$$Ifv!vh5@"#v@":V 5@"/ 4  aV$$Ifv!vh5@"#v@":V 5@"/ 4  a$$Ifv!vh55Z5:#v#vZ#v::V 55Z5:/ / / 4  a$$Ifv!vh55Z5:#v#vZ#v::V 55Z5:/ / / 4  a$$Ifv!vh55Z5:#v#vZ#v::V 55Z5:/ / / 4  a$$Ifv!vh55Z5:#v#vZ#v::V 55Z5:/ / / 4  aV$$Ifv!vh5@"#v@":V 5@"/ 4  aV$$Ifv!vh5@"#v@":V 5@"/ 4  aV$$Ifv!vh5@"#v@":V 5@"/ 4  a^@^ Normal 1$*$7$+B*CJOJPJQJ^J_HaJmH sH tHDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List NON Heading x$CJOJPJQJ^JaJ6B@6 Body Text x(/@( List^JH"@"H Caption xx $6CJ]^JaJ.O2. 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