RegistrationStep 1 of 425%Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Professional BackgroundPlease 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 ExperienceAre you a California-licensed attorney? (Attorneys licensed in other states should check No) * Yes NoAre you a California-licensed LMFT, LCSW, LPCC, or LEP? (Professionals licensed in other states should check No) Yes NoFor California-licensed professionals: please provide your CA Bar Number (attorneys) or License Number (LMFT, LCSW, LPCC, LEP)Secondary EmailIn 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 aboveCourse Selections and PaymentTraining Courses - to enroll please select course(s) Advanced Issues in Technology & Online Mediation (June) Co-Parenting Specialist Certification (Sept/Oct. Early Bird) Advanced Mediation Training (July - Topic Focus Support Issues) Early Bird 40-Hour Mediation Training (September) Early Bird Advanced Mediation Training (November) Early Bird Bill Eddy High Conflict Mediation Training (Nov.)Study Groups - to enroll please select group(s) Mosten Ousky Collaborative Practice Consultation and Study Group (remaining sessions) Marketing Consultation and Study Group w/Susan Guthrie (remaining sessions) Practice Building Group w/Woody Mosten Co-Parenting Consultation & Study Group (remaining sessions)Training Price: Total Coupon Payment Method - Click on PayPal button to pay using PayPal account OR credit card/bank account (option displays on next screen)PayPal CheckoutMasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ