Mentor Mediator Training 2020
Date: March 27, 2020
Location: Kaufman House Training Facility, Bethel College
2515 College Avenue
North Newton, KS 67117
Name as you wish it to appear on course certificate and name-tag. One registration form per person required.
First Name *
Your answer
Your answer
Last Name *
Your answer
Do you have experience as a Mentor Mediator? If so, briefly explain. *
Your answer
Mailing Address
Street Address/PO Box *
Your answer
State/Province *
Your answer
City *
Your answer
ZIP (Postal Code) *
Your answer
Preferred Phone *
Your answer
Email Address *
Your answer
Registration Fee
$100 regular price; $60 for volunteers who receive no payment for mentoring from either mentees or an agency
Refund Policy
If you must cancel your registration, do so as soon as possible. A refund, minus a $20 processing fee, will be made if cancellation is received no later than seven days prior to the training.
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
Special assistance required? If none, leave blank.
Your answer
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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