Registration Form for
Certificate Program for Mediation

June 15-16, August 3-4, and September 14-15, 2007
Cortina Inn & Resort, Killington, Vermont

Please print this page, fill out the Registration Form, and Fax it to:   802 457-1501
OR Mail it to: Woodstock Institute for Negotiation, Pomfret Stage Road-Drawer 29, Woodstock, Vermont 05091

You can also register over the phone by calling 800 457-3211

Name: _____________________________________________ I go by (for Name Tag): __________________

Company/Organization:  ________________________________________ Position: ____________________

Street Address: ______________________________________________________________________________


City: _____________________________________________ State: _______________ ZIP: ______________

Work Phone: ____  ___________     Home Phone: ____  ___________     Fax: ____  ___________

E-Mail Address: ____________________________________________________________________


___ Please Register me for the Certificate Program for Mediation  $ 2,295.00  
Payment Plan:

___ Payment Plan One: Payment of the full amount of the Training 
less a $100.00 reduction or $2,195.00.
Full payment due on or before April 27, 2007                           $2,195.00   $ _________ 

___ Payment Plan Two: Payment of the full amount of the Training 
Full payment due on or before May 25, 2007                             $2,295.00   $ _________ 

___ Payment Plan Three: Payment of $765.00 for each 2-day Session 
with each payment payable at least 21 days prior to each session 
and with a $50.00 late payment fee for any payment not received 
by WIN by each due date. (Total Payments = $2,295.00)  
First Payment due on or before May 25, 2007                            $  795.00   $ _________ 

___ Payment Plan Four: Payment of an initial payment of $1,095.00 
and then payment of the balance of $1,200.00 by 12 monthly payments 
of $100.00 plus interest at 1% per month on the outstanding balance
[ANNUAL PERCENTAGE RATE = TWELVE PERCENT (12%)] with each payment 
due on the 25th of each month beginning on June 25, 2007 and with a 
20.00 late payment fee for any payment not received by WIN on or 
before a payment date. (Total payments = $2,373.00 if all payments 
are made on time) 
Initial Payment due on or before May 25, 2007                          $1,095.00   $ _________ 

Late Payment fee if initial payment Recieved by WIN after May 25, 2007 $  100.00   $ _________

     Total Amount Due                                                              $__________


___ Payment Enclosed             ___ Payment will be mailed 
         (Please make check Payable to "Woodstock Institute for Negotiation")

Please Charge to: __ VISA    __ MasterCard    __ American Express    __ Diners Club

    Card Number: _______________________________________   Expires: ___ _____

    Name as it appears on card: _____________________________________________

    Signature: ___________________________________

If you are electing Payment Plan Three or Payment Plan Four, please sign and date to indicate 
your agreement to the payments due in the future and to the late penalty fees:

    Signature: ___________________________________ Date: _____________

Policies of the Woodstock Institute for Negotiation for this Program:

Cancellation Policy: Up to 21 days prior to the first session of the Certificate Program for Mediation (May 25, 2007), you are allowed to cancel your registration entitling you to a refund of your payment less a cancellation fee of $100.00.   No refunds will be given after this time and all payments under Payment Plans 2 and 3 will be due and payable as set forth above, but you will be allowed to send a substitute person to the Certificate Program for Mediation you registered for OR you or your substitute may attend a future Certificate Program for Mediation for a re-registration fee of $100.00.

If you are not able to print this Registration form, please send us an e-mail or call us and we will
fax or mail the Registration Form to you.

If you have any questions, please call us Toll Free at:
800 457-3211

March 30, 2007


Woodstock Institute for Negotiation
Pomfret Stage Rd - Drawer 29
Woodstock, Vermont  05091-0029
United States of America
Toll Free in USA & Canada:  800-457-3211
Telephone:  802-457-3211
Fax:  802-457-1501
e-mail address: