Canadian International Institute of Applied Negotiation

Registration Form

ADR Certificate Program & Modules I, II, and III

Register today: (1) Online;  (2) By Mail;  or (3) By Fax

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:

CITY:        

PROVINCE:                                                              POSTAL 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.

We reserve the right to cancel an upcoming course should there be insufficient enrolments. While all reasonable efforts will be made to notify course participants in a timely manner should a course need to be canceled, we will not be held liable for any costs whatsoever incurred whether direct or indirect by participants should such a course cancelation need to be made.

PAYMENT OF REGISTRATION FEES

OTTAWA COURSE FEES

SELECTION (please indicate date and module choice)

*Module I

$2,200 + $286 HST = $2486

Tuesday August 16 - Friday August 19, 2011 (Ottawa)

Tuesday February 21 - Friday February 24, 2012 (Ottawa) 

*Module II

$2,200 + $286 HST = $2486

Module III

$2350 + $305.50 HST = $2655.50

Monday October 17 - Thursday October 20, 2011 (Ottawa)

Monday October 15 - Thursday October 18, 2012 (Ottawa)

Special Programs

*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. Do you wish to have a tax receipt issued? 

  YES             NO

Please invoice my employer.  Billing information as follows:

Company:

Attention/Reference:

Address:

City/Province:

Postal Code:

My cheque or money order is attached (made payable to CIIAN)

Registration closes two weeks prior to each course. Early registration will help ensure a place.  Please return this completed form with payment to: