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*September 21, 2016 1-5pmSeptember 24, 2016 9am-1pmOctober 19, 2016 1-5pmOctober 22, 2016 9am-1pmNovember 16, 2016 1-5pmNovember 19, 2016 9am-1pmDecember 14, 2016 1-5pmDecember 17, 2016 9am-1pmEmail* Enter Email Confirm Email Name as Listed in Lawsuit* First Last If you do NOT wish to attend the Seminar with your co-parent, provide his/her name here:Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you live within the Savannah City Limits?YesNoWhich county do you live in?ChathamEffinghamBryanBullochLibertyOtherCounty 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 Fee Price: $45.00 Fee 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.