Information about Workshop Being Applied for:

Workshop Title:

Workshop Dates:

Information about Registrant:

Name:

Employer:

Position:

Mailing address:

Telephone (Office):

Telephone (cell):

Your email

Returning this Form and Payment:

• - Mail this form and payment to 138 Flora Street, Ottawa ON K1R 5R5; or
• - Email this form to rmoore@mdrassociates.ca and e-transfer payment or mail payment to 138 Flora Street, Ottawa ON K1R 5R5; or
• - Call (613) 230-8671 to register and discuss other payment options (for groups).
• - Please make cheques payable to MDR Associates Conflict Resolution Inc.

Further Information:

• - For further information about this workshop, or obtain answers to any questions, please contact Richard Moore at rmoore@mdrassociates.ca or at 613-230-8671.
• - Training materials and other information will be sent to each registrant by email prior to the commencement of workshop.