REGISTRATION FORM (print, then mail or fax)(PLEASE TYPE OR PRINT CLEARLY) FIRM/COMPANY: __________________________________________________________ NAME OF CONTACT:________________________________________________________ Street Address: ________________________________Ste/Unit#_______________ City, State, Zip Code: _________________________________________________ Phone: ( ) ________________________ Fax:( ) ____________________________ ______ # of persons attending (see cancellation fees clause above). (List individual names here, on back or on a separate
sheet.) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (All members are welcomed as well as associates-i.e., lawyers, CPAs, Brokers, assistants, family, etc.) THESE RULES APPLY FOR MEDIATION TRAINING ONLY: ********************************************** ELD Mediation Services certifies that this Activity has been Approved for MCLE credit by the State Bar of California in the Amount of 30 hours (of which 1 hour is of Ethics, 1 hour is of Law Practice Management, and .5 hour is of Elimination of Bias). Also, by the Board of Behavioral Sciences. *********************************************************** In order to receive credit, in-house education activities, (including private training) must be scheduled at a time and location so as to be free of intrusions from telephone calls and other office matters, pursuant to Section 7.1.5 of the State Bar of California MCLE Rules and Regulations. ***************************************************************** R. E. Estate Brokers, CPAs, RNs, continuing education credit is possibly available for you. Please call for details. ******************************* Credit for Social Workers has been granted in the past. Please indicate if this is something you desire for in order that we may update our application. Credit for M.F.C.C.s is pending. Please inform us if you are interested in this credit. WHICH LECTURE ARE YOU INTERESTED IN: List Name of Organization/Firm/Company as is Above: __________________________________________________________________ SCHEDULED : DATE:_______________________________________ TIME:________________________________________ LOCATION: ___________________________________ ___________________________________ ___________________________________ Location Phone: (____)___________________________ Estimated number of participants:__________________ (Date given to ELD:_____________) Final Estimated number of participants:______________ (Date given to ELD:_____________) (This figure must be given within 3 days of the lecture/training) Estimated costs/fees: $________________(per participant-strike if not applicable) Final cost/fees: $________________ (Travel costs itemized and attached hereto-to be determined within 30 days of conclusion of lecture/training-strike if not applicable) AGREEMENT/CONTRACT: The undersigned agrees that this document is considered a contract between their organization and E. L. D. MEDIATION SERVICES. They also certify that they are the authorized individual to enter into and execute this contract by and on behalf of the organization (corporate or otherwise). The undersigned does hereby agree to pay the cost of the lecture prior to the commencement of the lecture, and any applicable cancellation fee as described above, as well as any and all final costs/fees as stated herein above.
So Agreed/Certified: ________________________________ ___________
_______________________________________________ E. L. D. Mediation Services: By: ____________________________ _______________ Edna L. Deeb Date If you send the lawyer, law firm or mediation/arbitration service an e-mail through this website service, your e-mail will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You should not send sensitive or confidential information via this website or the e-mail service included therein. The lawyer, law firm and mediation/arbitration service to whom you are writing may not choose to accept you as a client. Moreover, as the Internet is not necessarily a secure environment, it is possible that your e-mail sent via the Internet might be intercepted and read by third parties. Thank you for your understanding and cooperation.
EDNA L. DEEB, ESQ.
E. L. D. MEDIATION SERVICES
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