First National Symposium on Ethical Standards
for Elder Mediation

April 19-20, 2007

ONLINE REGISTRATION FORM

Please complete and submit the form below. Select your Break Out Session preferences and Thursday Evening Dinner choice. Symposium Registration is $375 if submitted by March 15, and $425 if submitted thereafter. Registration deadline is April 10.

Registration Fees include Symposium, two (2) breakfasts, two (2) lunches, and Thursday Evening Dinner & Program.

To pay by check or money order, click on the link below for a printable .PDF Registration Form.

CLICK HERE FOR A PRINTABLE .PDF SYMPOSIUM REGISTRATION FORM

Name:
E-Mail Address:
Address 1:
Address 2:
City:
State/Province:    Zip:
Phone:
Fax:
Cell:
Attorney Lic. No.
if requesting Continuing
Legal Education Credits:


BREAK OUT SESSIONS
For EACH of the Break Out Sessions, please enter a 1, 2, or 3 in the boxes below to select your top three (3) choices in order of preference.
Break Out Session I:

I-1. Should capacity to mediate differ from legal and medical determinations of capacity? When do they overlap and when do they clearly separate?
I-2. Who should determine capacity to mediate? How should a determination be made?
I-3. What is the impact on the mediation process when there has been a legal or medical determination of incapacity?
I-4. What is the risk of mediation for a person with cognitive impairment?
I-5. Are separate standards needed to address capacity issues in elder mediation? If so, what may they be?
 

Break Out Session II:

  II-1. Intake Protocols
  II-2. Training and Other Requirements
  II-3. Capacity Concerns
  II-4. Dual Practice
  II-5. When to Terminate a Case or Refuse to Mediate
 

Thursday Evening Dinner

Entrée Selection:
  Chicken
  Salmon
  Vegetarian
  Kosher
Please describe any special dietary needs:

 

Continuing Legal Education Credits

CLE Credits are available for CA, NY and PA. Selecting CLE Credits adds $55 per state to the Symposium fee.

I would like CLE Credits for:
  CA     NY     PA

Would you like CLE Credits for a state outside CA, NY or PA? Yes   No
If yes, list state(s)

You will be notified if CLE Credits are available. An additional fee of $55 per state will be required to be paid upon notification of approval.

Paying the CLE Credits fee for an additional state: If you have already registered and paid for the Symposium, and have been notified that CLE Credits are available for your state, please enter only your Name and E-Mail Address at the top of this form, click the "Yes" button above, and enter the state for which you wish to receive credit. When you submit this form, you will see the Payment Options page. Scroll to the bottom of that page where there is a button for the $55 fee. Click on that button to go to the PayPal payment page.

Thursday Evening Dinner & Program Only: If you would like to attend the Thursday evening Dinner & Program without Symposium Registration, check the box below. The fee is $85.

Dinner & Program only: Yes

NOTE: When you click on the Submit Registration button below, you will be taken to a page where you can choose the appropriate payment options for the selections you have made. You will then be redirected to our PayPal page where you can securely enter your credit card information.
 

 

If you would like more information, please contact Symposium Coordinator Kathryn Mariani at (610) 277-8909 or eldermediation@verizon.net.

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