SMA: Coordinator's Roundtable: Registration Form

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School Mediation Associates' Coordinators' Roundtable 2001 Registration Form
		Last Name: ____________________ First Name: _____________________ School: _________________________________________________________ School Address : ________________________________________________ City: _____________________________ State: ______ Zip: ________ Work Phone: _______________________ email: _________________________________________________________ When did you start your program?: _______________________________ Number of cases mediated in '00-'01: _________ Have you ever attended SMA's Coordinators' Roundtable? Yes _____ No _____ If yes, is there anything you feel that we should definitely do or not do again? _________________________________________________________________ _________________________________________________________________ 1. Take a leadership role! We encourage experienced coordinators to co-facilitate a roundtable session. We will provide a small stipend and a co-facilitator. What have you discovered that you would like to share with others? What are you excited about? Please list topics you would like to facilitate: 1. ______________________________________________________ 2. ______________________________________________________ 2. We create an agenda for the Roundtable based upon your needs. Put a check next to the topics that most interest you. __ Introduction to PM Coordinating __ PM and the MA Curriculum Frameworks __ The Use of Private Sessions __ Confidentiality Policies __ Tips to Increase Scheduling Efficiency __ Conducting Intake Interviews __ Ethical Dilemmas __ Ideas for Ongoing Training __ Mediating Large Group Disputes __ Handling Mediators who Misbehave __ Mediating Disputes Involving Harassment __ To Be or Not to Be In the Room During Sessions __ Ten Best Ideas for Generating Referrals __ Building Support for Your Program __ Combining Mediation & Discipline __ Introduction to Transformative Mediation __ Other: __________________________________________________ __ Other: __________________________________________________ 3. Method of payment (Please let us know if the fee presents an obstacle to your attendance. We'll try to accommodate all who want to attend.) __ I have enclosed my registration check for $95.00 ($80.00 prior to 6/1/01) OR __ Send invoice for $95.00 ($80.00 prior to 6/1/01) to : __________________________________________________________ (Specify purchase order number if possible!) School Mediation Associates is about to publish a FREE email newsletter with articles and helpful tips for peer mediation coordinators. Please write your email address below if you would like to receive this monthly newsletter. My email address is: _______________________________________________ Send registration form and check to: Roundtable Registration School Mediation Associates 134 Standish Road Watertown, MA 02472 Call 617-926-0994 if you have questions about the Coordinators' Roundtable. (end)