Transitional Parenting Seminar Registration Transitional Parenting Seminar Registration 4 hour class required to be attended by all parents in every divorce, legitimation, or modification case. Only exemption is when a party lives farther than 50 miles outside of Savannah. PLEASE SUBMIT ONE REGISTRATION FORM PER PERSON.Date of Transitional Parenting Seminar*June 17, 2015 1-5pmJune 27, 2015 9am-1pmJuly 15, 2015 1 - 5pmJuly 25, 2015 9am-1pmAugust 19, 2015 1 - 5pmAugust 22, 2015 9am-1pmSeptember 16, 2015 1 - 5pmSeptember 26, 2015 9am - 1pmOctober 21, 2015 1 - 5pmOctober 24, 2015 9am-1pmNovember 18, 2015 1 - 5pmNovember 21, 2015 9am-1pmDecember 16, 2015 1 - 5pmDecember 19, 2015 9am-1pmEmail*Enter EmailConfirm EmailName as Listed in Lawsuit*FirstLastIf you do NOT wish to attend the Seminar with your co-parent, provide his/her name here:Address*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodeCounty Filed In*Phone (###)###-####*Civil Action NumberWhat type of case brought you to the Transitional Parenting Seminar?*DivorceLegitimationModificationGrandparent Custody or VisitationSeminar Fee $45.00 Per Person (Non-Refundable)Registration is for one person only. Each co-parent must register separately. ALL REGISTRATION FEES ARE NON-REFUNDABLE! You may apply for a fee waiver by submitting the Request for Fee Waiver application found on the Home Page. The Request for Fee Waiver must be received more than three (3) days prior to the Seminar you have elected to attend.Payment Type (NON-REFUNDABLE)*Pay Online Through PayPalPay at the Mediation Center (cash or credit)Have applied for fee waiver and will pay at Mediation CenterPayPal InstructionsIf a third-party is paying for your registration fee via PayPal, the third party MUST put YOUR NAME in the "Note to Seller" option on PayPal's "Review your information" page in order for you to get credit for that payment.NON-REFUNDABLE Seminar Registration FeePrice: $45.00Fee Waivers or Reduction InformationTo apply for a fee waiver or reduction, please complete the Request for Waiver Form which can be found on the homepage of our website. The Request must be sent to the Mediation Center no less than 3 days prior to your scheduled mediation. Eligibility for a waiver or reduction in fee will be based upon the Federal Poverty Guidelines. Confidential Statistical Information for United WayAs a non-profit corporation, the Mediation Center is required to report demographic information to the United Way and other funding sources. Your personal information will be confidential. Current Age*0 - 19 yrs20-34 yrs35-54 yrs55 - 64 yrs65 - 74 yrs75 - 84 yrs85+ yrsEthnicity*Black/ African AmericanAsianWhite/ CaucasianHispanic/ LatinoNative AmericanPacific IslanderMulti-RacialOtherFamily Annual Income Before Taxes*$0-$9,999$10,000 - $14,999$15,000 - $24,999$25,000 - $34,999$35,000 - $49,999$50,000 - $74,999$75,000 - $84,000$85,000+Gender*MaleFemaleTransgenderHas there been violence or abuse between you and the other party during your relationship?*YesNoThere have been false accusationsThis registration form is confidential. The information you provide will NOT be provided to any person or entity. Please respond accurately to help us collect useful statistics.CommentsThis field is for validation purposes and should be left unchanged.