Limited Case Management Training April 25 and 26, 2019
Date: April 25 and 26, 2019 8:00 am - 4:30 pm
Location: KIPCOR
2515 College Ave.
North Newton, KS 67117
Name
Name as you wish it to appear on course certificate and name-tag. One registration form per person required.
First Name *
Your answer
MI
Your answer
Last Name *
Your answer
Professional Licenses held *
(LMLP, LMSW, JD, etc.)
Your answer
Organizational Affiliation/Title *
Your answer
Your Background
Kansas Statute 23-3508(d) and Supreme Court Administrative Order 266 set out the qualifications (in addition to training) required for anyone seeking to serve as a domestic case manager. These are not pre-requisites for attending this training - anyone may attend - but it helps our planning to know your readiness to begin a case management practice.
What is your background for this class - Question 1 *
Please check which of these requirements you ALREADY meet:
What is your background for this class - Question 2 *
Are you CURRENTLY qualified to conduct mediations?
What is your background for this class - Question 3 *
Are you CURRENTLY A STATE-APPROVED DOMESTIC mediator?
What is your background for this class - Question 4 *
Do you have experience as a DOMESTIC mediator?
Mailing Address
Street Address/PO Box *
Your answer
City *
Your answer
State/Province *
Your answer
ZIP (Postal Code) *
Your answer
Work Phone *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Registration Fee
$300 if received by 4:00 PM on April 5; $350 thereafter.
Refund Policy
If you must cancel your registration, do so as soon as possible. A refund, minus a $30 processing fee, will be made if cancellation is received no later than 4:00 PM, April 5, 2019.
Cancellation Policy
KIPCOR may cancel or postpone any training course because of insufficient enrollment or other unforeseen circumstances. If there is a cancellation or postponement, liability is limited to the registration fee.
Additional Registration Information
Refreshments and materials provided. Continuing Education credits for Attorneys, Mediators, and Social Workers are requested and pending.
Special dietary needs? If none, leave blank.
Your answer
Special assistance required? If none, leave blank.
Your answer
Payment Options
Form of payment *
Checks made payable to KIPCOR can be mailed to KIPCOR P.O. Box 276, North Newton, KS 67117. Please call our office at (316) 284-5217 to make a credit card payment. Forms of credit accepted are Discover, MasterCard, and Visa.
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