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2012 Mediation Training Registration Form

2012 Mediation Training Registration Form

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Published by narwebteam

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Published by: narwebteam on Apr 06, 2012
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08/05/2014

 
Registration Form
NATIONAL ASSOCIATION OF REALTORS
®
 
Mediator/Mediation Training(available at http://www.realtor.org/mempolweb.nsf/pages/mediationtraining) The
June 27, 28, and 29, 2012
seminar will be held at the NATIONAL ASSOCIATION OF REALTORS
®
 
building inChicago, 430 N. Michigan Avenue, on the second floor. Attendees must participate in all scheduled sessions. Although prior training and/or experience in mediating real estaterelated disputes is helpful, it is not necessary to have prior training/experience to attend. All are welcome. Please completethe enclosed attendee profile. Attendees (or their sponsoring organizations) are responsible for their transportation, lodging, meals (other than thoseprovided by NAR), and incidental costs.Reservations must be made directly with the Courtyard by Marriott Magnificent Mile by calling 312-573-0800 or 800-321-2211. Please reference “NAR’s Mediation Meeting” to take advantage of the $169 per night room rate.Only the
first
fifty (50) registrations that are received will be accepted.
Information provided immediately below used for attendee roster and to contact you regarding the program.(Please print or type)
Name:
 
Nickname (optional):
 
 Address:
 
City:
 
State:
 
Zip:
 
Telephone:
 
Fax:
 
E-mail:
 
Board or Association:
 
Please attach to your registration form a description of any disability requiring special services at this seminar.Completed registration forms must be accompanied by an attendee profile to optimize attendees’ learning experience, andcan be sent to the Member Policy Department, NATIONAL ASSOCIATION OF REALTORS
®
, 430 North Michigan Avenue,Chicago, Illinois 60611 (e-mailBbarajas@realtors.orgor fax to Bernice Barajas in the Member Policy Department at 312-254-3188).Registration fee is $150 (nonrefundable after June 1).
 
check enclosed, make payable to:NATIONAL ASSOCIATION OF REALTORS®, account # 01-358-321credit card payment:
Visa
MasterCard American Express Diners Club
Credit Card #
 
Exp. Date
 
Cardholder NRDS ID# (required)
 
Signature
 
Cardholder name and billing address (required)
 
Attendee Profile
NATIONAL ASSOCIATION OF REALTORS
®
 
Mediator/Mediation Training(available at http://www.realtor.org/mempolweb.nsf/pages/mediationtraining)To optimize attendee’s learning experience, this form must be submitted with the registration form. Although prior formal training in mediation and/or practical experience in mediating disputes between REALTORS
®
is helpful, prior training/experience is not required. All individuals affiliated with the REALTOR
®
family are welcome to attend.
Attendee information
Name
 
Board or Association
 
State Association
 
Number of years as a broker 
 
Number of years as a sales licensee
 
Number of years as an association executive or staff specialist
 
Other, please explain
 
Professional designations
 
Professional standards experience (approximate)
Local Grievance Committee# years
 
Local Professional Standards Committee# years
 
State Grievance Committee# years
 
State Professional Standards Committee# years
 
Local Board of Directors service# years
 
NAR Professional Standards Committee# years
 
State Board of Directors service# years
 
Mediation officer# years
 
Staff# years
 
Mediations conducted (how many) #
 
Mediation skills
Formal training as a mediator YearTraining provided byHours of instruction
 
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