Family & Separating Couples 32 Hour Course
CPD Course
Registration Form
First Name: Click here to enter text.
Last Name: Click here to enter text.
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Location (Please select your preferred location)
☐ Dublin: 12th & 13th October and 2nd & 3rd November 2017, Ashling Hotel
☐ Cork: 28th & 29th September and 26th & 27th October 2017, The River Lee Hotel
The Course (Please select as appropriate)
☐ Full 4-Day Course
☐ Individual Modules
Day 1
☐ Half day:
☐ Half day:
Day 2
☐ Full day:
Day 3
☐ Full day:
Day 4
☐ Half day:
☐ Half day:
Module 3: Couple Dynamics - Engaging in the Process
Module 4: Domestic Abuse and Screening
Module 1: Family Law Matters
Module 2: Family Mediation Process
Module 5: Parenting
Module 6: Child Protection Issues
Module Exemptions: Please apply to the MII for exemptions from modules
Course Timings: 8.45 am – 12.45pm and 1.30pm – 5.30pm
Admission Requirements
Completion of the RoundTable recognised 60 hour Certified Mediation Training
Programme or similar certified programmes which meet the MII criteria. Please attach a
photocopy of your training certificate or proof of your MII membership to this form.
Where have you heard about us?
☐ from a colleague
☐ from a friend
☐ from the internet
☐ other, namely Click here to enter text.
Costs & Payment
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

€275.00 per full day module
€184.00 per half day module
€1100 for complete course – minus 10% early enrolment discount on full
fee paid before 14th August.
Terms
Places are allocated on enrolment. Payment to follow within 7 days by bank transfer, or cheque in the requisite
amount, payable to RoundTable. If you need an invoice to make the payment please let us know.
In the event that the course is over subscribed we will give priority to those who wish to do the full 32 hours;
followed by those who wish to do a full day; then those who wish to do one module only. MII members are given
precedence at each priority stage.
There is no course reservation – only payment will secure a place. If you are in an organisation it may be easier for
you to pay personally and reclaim it from the organisation to secure your place.
Attendee fee covers training and registration fees, teas/coffees, and course materials.
Cancellation Policy:
If you cancel 14 days before the course you will be refunded your payment less €25.00 administration charge. You
will not be entitled to a refund if you cancel less than 14 days before the course.
Payment options
§ Cheque payable to RoundTable, 28 South Bank, Crosses Green, Cork, T12 EF22.
§ Bank Transfer When making a transfer please be sure to use your name as a reference so that the payment can
be identified when it arrives.
Payment in Euro
IBAN: IE59 AIBK 9341 7867 1570 38
BIC: AIBKIE2D
For further information please contact [email protected], Telephone: (021)2339350, (01)5390212; or consult
our website http://www.roundtable.ie/
RoundTable is committed to protecting the rights and privacy of individuals in line with the Data Protection Legislation