Conference Registration Form

Please use the form below to register for the 2010 Annual Conference "MEDIATION MEDLEY" - Northeast Mediation Conference.
Brought to you by The NY State Council on Divorce Mediation

For a complete description of the conference, please click here

Please Note: You can either choose the option to pay-online (using secure Google checkout) or mail a check for your conference fee.

Today Is: Saturday, February 04th, 2012
You Are No Longer Eligible For Early Bird Rates.

Select Membership Status:
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** MEMBERS OF OTHER STATE MEDIATION ORGANIZATIONS WHO DO NOT
PRACTICE IN NEW YORK ARE ELIGIBLE FOR NYSCDM MEMBER RATES **
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I Plan On Attending The Pre-Conference (4/29/2010):  

Pre-Conference Fee:
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I Plan On Attending The Conference For:  

Conference Fee:
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Total Amount Due:



Name:
Address:
Phone: Fax:
Email:
I would like to carpool: .

I will be paying for my membership via:
*there is an additional 3% fee for using Secure Google Checkout.