40-Hour Training Waitlist Registration

1Basic Information

2Other Information

3Payment

Select Training Dates(Required)

June 10, 11, 12, 16, 17, 2026

Who are you registering?(Required)

I'm registering for myself

I'm registering for someone else

Preferred first and last name in class(Required)

First Last

Name(Required)

First Last

Phone number where you can be reached immediately during class(Required)

Email to receive role play info during class(Required)

Your Phone Number(Required)

Your Email(Required)

Occupation/Profession(Required)

City where you live(Required)

Name as you would like it to appear on your Certificate of Completion(Required)

Digital Certificate

Please also provide a digital certificate that I can post on social media

40-Hour Basic Mediation Training(Required)

Price:

Select Payment Type(Required)

Check

Credit Card

Purchase Order

Send Check To:
Dispute Resolution Center
1700 Guadalupe, Suite 2.700
Austin, TX 78701

Send Purchase Order To:
Rita Rancken
rita@austindrc.org

Payor(Required)

First Last

Full name of the person making the payment

Attendee(Required)

First Last

Full name of the person attending the mediation

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Coupon

Total

40-Hour Basic Mediation Training

June 2026 40-Hour Basic Mediation Training Waitlist Registration

Address:

Contact: