Registrant #1:

Title or File #:

Board/Association:

E-MAIL*:

Registrant #2:

Title or File #:

Board/Association:

E-MAIL*:

Registrant #3:

Title or File #:

Board/Association:

E-MAIL*:

Disabilities which require special services:

Class times are:

Apr. 27, 9 a.m. - 6 p.m. (lunch is scheduled)

Apr. 28, 8:30 a.m. - 6 p.m. (lunch/dinner are included)

Apr. 29, 8:30 a.m. - 12:30 p.m.

Hotel Accommodations may be made at the Holiday Inn Columbus City Center, 175 E. Town St., Columbus 43215 or call:

614.221.3281 or www.holiday-inn.com

Method of Payment: $265 per participant

Mediation I: $125

Mediation II: $175

Mediation Skills Graduates can take refresher course for: $100

Check Visa MasterCard Discover

Account #: Expires:

Name on Card:

Completed forms can also be faxed to: 614.241.2848...Courses will be held at OAR headquarters.