Last Name:  

First Name: 

School:


School Address:

Street:


City:


State:    Zip Code: 

Country: 

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. Check each topic in the appropriate column,
indicating how interested you are in that subject.

Very Interested   Interested

                         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 sent my registration check for $95.00 ($80.00 prior to 6/1/01)

		OR


 Send me an 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.