Application for August 30 and 31 and September 5, 6 and 7 2008 Dependency Training

Presented by David A. Wolfson, Primary Dependency Trainer

Register by thirty days prior to the training for $825; thereafter, the fee is $850 (which includes lunch and refreshments daily). No refunds will be made after two weeks prior to the first day of the training, and any cancellation prior to that date will be subject to a $25 administrative fee. If you are a full time State of Florida employee, inquire about a further discount.  You may substitute other individuals for applicants until one day prior to the beginning of the training. Enrollment is limited to 10 participants. David A. Wolfson reserves the right to cancel the training in which case all fees are fully refundable. This course meets the Florida Supreme Court training standards for certification as a dependency mediator. There are additional requirements for certification by the Florida Supreme Court which are described in the Florida Rules for Certified and Court Appointed Mediators (see http://www.flcourts.org/gen_public/adr/certify.shtml), and Florida Supreme Court Administrative Order SCAO 06-9

 Please mail this application along with your check or credit care information to David A. Wolfson; 1805 Bitter Root Trail; Tallahassee, Florida 32312

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Full Name as you wish it to appear on the certificate of completion:

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Address

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City, State, Zip

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Social Security Number

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Daytime Phone                                 Nighttime phone

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Fax                                                      E-Mail Address

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Profession                                         Highest Degree Earned

Credit Card Payment information

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Name on Card

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Type of Card

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Card Number

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3-4 digit security code

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Signature

Note, at the time of the training, there will only be one method to qualify for certification, the point system.  The minimum of a bachelor’s degree is necessary for certification, and, in that event, five (5) years experience as a mediator with a minimum of mediations  during that period is also required.  There are additional requirements.