• Email the form below via MWI's secure server.
   
• Call MWI at 800-348-4888 x21 to register over the telephone. MWI's office hours are 9:00 AM to 5:00 PM EST Monday through Friday.
   
• Fax a copy of this completed form with your credit card information to 617-973-9532.
   
• Print a completed form and mail it to: 

  MWI 
  4 Faneuil Hall - Fourth Floor 
  Boston, MA 02109
  ATTN: Training Registration

  (Checks should be made out to "MWI".)

Please provide the following contact information:

First Name
Last Name
Name to appear on name tag
Name to appear on certificate
Title
Company
Address
Address (cont.)
City
State
Zip Code
Country
Work Phone
Cell Phone
Home Phone
FAX
E-mail
Web

Payment:

Method	Method of Payment Check to be mailed VISA MasterCard American Express Discover
Cardholder Name
Card Number
Expiration Date

If using a purchase order, please provide the following information:

Purchase Order #
Account Name

Please provide a brief bio: 

Please describe why you have decided to take this training program: 

Please let us know how you became aware of MWI and our training programs: 

If registering for an advanced mediation training program, please identify when you completed your initial basic training program (minimum 30-hours), the name and phone number of the training provider, and your experience as a mediator, if any: 

Additional Information: 

Verification Code

Type the code you see above:
Having trouble reading the code? Click here for a new code.

Thank you for registering.  A confirmation email will be sent to you within two business days.  Should you have questions, please call 800-348-4888 x21 or send an email to mwi@mwi.org.

DISCOUNTS 

Early enrollment discount is available.  A 5% discount in addition to the early enrollment discount is available for groups of four or more from the same organization.  Please call 800-348-4888 x22 for details. 

NOTIFICATION 

A confirmation email or letter will be sent within two business days of MWI receiving your registration. 

CANCELLATIONS / TRANSFERS / SUBSTITUTIONS / MAKE-UP SESSIONS

Cancellations / Transfers:  Cancellations must be made in writing. A full refund is available up to 21 days before the start of a program. Cancellations received between 21 and 14 days before the start of a program will receive a refund, less a $75 administrative fee or registrants may make a one time transfer to another program within a one year period without incurring a $75 administrative fee.  No refunds will be made if a cancellation is made within 14 days of the start of a program.  Registrants may make a one time transfer to another program within a one year period without incurring a $75 administrative fee up to 14 days before the start of a program.  Registrants who transfer their registration more than one time will be charged a $75 administrative fee for each transfer.  Transferred registrations are not eligible for refunds.  MWI reserves the right to cancel a program for any reason and issue a full refund. 

Substitutions:  Registrants who are unable to attend may arrange with MWI to send a substitute in their place. Potential substitute registrants must complete the registration process at least 14 days before the start of a program.

Make-up sessions:  Participants must attend each hour of each session in order to receive a certificate of completion.  Participants who miss training hours due to illness or an emergency may apply to make up missed hours at a rate of $100 per five-hour block. Questions about this or any other MWI training policy should be directed to Chuck Doran, Executive Director at cdoran@mwi.org or 617-973-9739 x22.

Please contact Mediation Works Incorporated at 800-348-4888 x22 or mwi@mwi.org for more information.

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