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Registration FormNATIONAL ASSOCIATION OF REALTORS®  

Mediator/Mediation Training(available at http://www.realtor.org/mempolweb.nsf/pages/mediationtraining)

The June 27, 28, and 29, 2012 seminar will be held at the NATIONAL ASSOCIATION OF REALTORS®   building inChicago, 430 N. Michigan Avenue, on the second floor.

 Attendees must participate in all scheduled sessions. Although prior training and/or experience in mediating real estate

related disputes is helpful, it is not necessary to have prior training/experience to attend. All are welcome. Please completethe enclosed attendee profile.

 Attendees (or their sponsoring organizations) are responsible for their transportation, lodging, meals (other than thoseprovided by NAR), and incidental costs.

Reservations must be made directly with the Courtyard by Marriott Magnificent Mile by calling 312-573-0800 or 800-321-2211. Please reference “NAR’s Mediation Meeting” to take advantage of the $169 per night room rate.

Only the first fifty (50) registrations that are received will be accepted.

Information provided immediately below used for attendee roster and to contact you regarding the program.(Please print or type)

Name:   Nickname (optional):   Address:  City:   State:   Zip:  Telephone:   Fax:  E-mail:  Board or Association:  Please attach to your registration form a description of any disability requiring special services at this seminar.

Completed registration forms must be accompanied by an attendee profile to optimize attendees’ learning experience, andcan be sent to the Member Policy Department, NATIONAL ASSOCIATION OF REALTORS

®, 430 North Michigan Avenue,

Chicago, Illinois 60611 (e-mail Bbarajas@realtors.org or fax to Bernice Barajas in the Member Policy Department at 312-254-3188).

Registration fee is $150 (nonrefundable after June 1).

  check enclosed, make payable to:NATIONAL ASSOCIATION OF REALTORS®, account # 01-358-321

credit card payment:Visa MasterCard American Express Diners Club

Credit Card #   Exp. Date  Cardholder NRDS ID# (required)   Signature  Cardholder name and billing address (required)

8/2/2019 2012 Mediation Training Registration Form

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Attendee ProfileNATIONAL ASSOCIATION OF REALTORS

®  

Mediator/Mediation Training(available at http://www.realtor.org/mempolweb.nsf/pages/mediationtraining)

To optimize attendee’s learning experience, this form must be submitted with the registration form. Although prior formal training in mediation and/or practical experience in mediating disputes between REALTORS

®is helpful, prior 

training/experience is not required. All individuals affiliated with the REALTOR® family are welcome to attend.

Attendee information

Name  Board or Association  State Association  

Number of years as a broker    Number of years as a sales licensee  Number of years as an association executive or staff specialist  Other, please explain  Professional designations  

Professional standards experience (approximate)

Local Grievance Committee # years   Local Professional Standards Committee # years  State Grievance Committee # years   State Professional Standards Committee # years  Local Board of Directors service # years   NAR Professional Standards Committee # years  State Board of Directors service # years   Mediation officer # years  Staff # years   Mediations conducted (how many) #  Mediation skills

Formal training as a mediator 

Year Training provided by Hours of instruction

 

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Practical (“on the job”) training as a mediator, including dates. Attach additional pages if necessary.

 

Summarize experience as a mediator conducting mediations over the past three (3) years. Attach additional pages if necessary.

 

Please describe your primary mediation style (e.g., facilitative, evaluative, other).

 Other relevant training or experience.

 

Training experience

Experience in personally conducting mediator training, if any, over the past three (3) years. Please describe training. Attach additional pages if necessary.

 

Briefly describe training programs (other than mediation training) that you have personally conducted over the past three (3)years. Attach additional pages if necessary.

 

Please list any specific topics or issues you would like to see addressed in this seminar.

 

Important note: A completed attendee profile must accompany the registration form. Thank you.

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