Registration

Step 1 of 4

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Professional Background

Please select the option(s) that best describes your professional background/work experience, or enter your own description on the line provided. No specific professional background or experience is required; this information helps us tailor the course to our participant groups and set up corresponding records for CLE and CE credit, where applicable.

Attorney

Legal Field, Non-Attorney (Paralegal, Legal Assistant, LDP, Office Manager, etc.)

Mental Health Professional (MFT, LCSW, LPCC, LPC, etc.)

Financial Professional (CDFA, CPA, CFA, etc.)

Coach (Divorce Coach, Conflict Coach, etc.)

Other Professional Experience

Are you a California-licensed attorney? (Attorneys licensed in other states should check No) *

Yes

Are you a California-licensed LMFT, LCSW, LPCC, or LEP? (Professionals licensed in other states should check No)

Yes

For California-licensed professionals: please provide your CA Bar Number (attorneys) or License Number (LMFT, LCSW, LPCC, LEP)

Secondary Email

In the event that your email security/spam filter prevents our communications from reaching your inbox, a secondary email will allow us to contact you with course information until the issue can be corrected.

Recording Information and Release

We record all trainings for internal use and development, and we sometimes use screenshots or training segments for marketing. Recordings are not available to participants and are not distributed publicly except as described. Small group breakout room exercises are not recorded during the training. If you have any questions regarding the recording release, please contact alison@mostenguthrie.com.

By executing this form and participating in the Mosten Guthrie 40-Hour Family and Divorce Mediation Training, you hereby consent to the recording and distribution of reproduction(s) of your voice and image as a participant in the training program. You hereby acknowledge that Mosten Guthrie Academy is the sole owner of all rights in and to the training program, and the recording(s) thereof, for all purposes; and that Mosten Guthrie Academy has the unfettered right, among other things, to use and distribute the recording(s) of the training program, or any portion thereof, and your video and/or audio as embodied therein, together with your name, professional information, photograph or likeness (including, without limitation, any photographs or other material provided by you) in any and all media or formats, throughout the world, in perpetuity.

Recording Notification and Consent(Required)

By executing this form and participating in the Mosten Guthrie Training or Group, you hereby acknowledge and consent to the recording and distribution of reproduction(s) of your voice and image as a participant in the training program. You hereby acknowledge that Mosten Guthrie Academy is the sole owner of all rights in and to the training program, and the recording(s) thereof, for all purposes; and that Mosten Guthrie Academy has the unfettered right, among other things, to use and distribute the recording(s) of the training program, or any portion thereof, and your video and/or audio as embodied therein, together with your name, professional information, photograph or likeness (including, without limitation, any photographs or other material provided by you) in any and all media or formats, throughout the world, in perpetuity.

I acknowledge that I have read and agree to the above

Recording Information and Release

Course Selections and Payment

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