Application for Basic & Family Mediation Training

Individuals interested in receiving 40-Hour Basic Mediation Training or 30-Hour Family Mediation must submit a training application and training fee. Since seating is limited, we strongly encourage training applications and fees be submitted on the same day. Payments for classes in 2019 will be accepted beginning Jan. 1st.

The preferred method of payment is by credit or debit card. Please call (817) 877 – 4554 during regular business hours (8:00 AM – 5:00 PM Monday through Friday) to pay by credit or debit card. Payments in the form of a money order, personal check, or cashier’s check should be made payable to DRS North Texas and mailed to: 4304 Airport Freeway, Suite 100, Fort Worth, Texas 76117.

TRAINING APPLICATION

Personal Information










Employment

If "Yes," where?




 ADR Armed Forces Attorney Business/Finance Clergy Construction Education (K-12) Education (University) HR IT Law Enforcement Marketing/PR Medical Paralegal Real Estate Social Work Other








Education

High School:




College/University





College/University





Voc/Bus





References:

Please list two persons, not related to you, and you have known at least one year.

Reference 1






Reference 2





Mediation Experience





Name:
Phone:
Relationship:

Please read the following sign and date.

I affirm that all information given is true to the best of my knowledge.

I understand Dispute Resolution Services of North Texas (DRS NORTH TEXAS INC.) teaches mediation to prepare individuals to volunteer as mediators at DRS NORTH TEXAS INC.

I understand that:

a) my service as a DRS NORTH TEXAS INC. volunteer mediator is a privilege; and
b) knowingly submitting false information; and/or failing to abide by DRS NORTH TEXAS INC. established standards of performance and/or behavior may result in dismissal from the Volunteer Mediator Program at the sole discretion of DRS NORTH TEXAS INC.

I agree to abide by all obligations and rules relevant to service as a volunteer mediator of DRS NORTH TEXAS, INC.

I grant permission to DRS NORTH TEXAS INC.:

a) to post photos, video, or other items of my participation in training on their social media accounts, websites, and printed marketing materials, hereinafter referred to as "Materials";
b) I release the agency, the agency's representatives, employees, managers, officers, and directors, from all claims and demands arising out of or in connection with any use of said "Materials"; and
c) I acknowledge and agree that no sums whatsoever will be due to me as a result of the use of the "Materials" or any rights therein.



Training Fees


Regular Price $550
Early Registration $499

Regular Price $325
Bundled with Basic $299

A training fee is required to finalize registration for Basic or Family Mediation Training. Fees can be submitted by credit card, money order, personal check, or cashier's check.

To pay by credit or debit card, please call (817) 877 - 4554 during regular business hours Monday through Friday 8:00 AM - 5:00 PM. Money orders, personal checks, and cashier's checks should be made payable to DRS North Texas and mailed to: 4304 Airport Freeway, Suite, 100, Fort Worth, Texas, 76117.

Year:

Year: