The Mediation Center

<HTML>
<HEAD>
<META name="description" content="The Mediation Center, with Director James C. Melamed, J.D., is a nationally and internationally prominent provider of mediation training, resources and services.">
<META name="keywords" content=The Mediation Center, Eugene, Oregon, mediation,
mediator, mediators, conflict, conflict resolution, training, mediation training,
conflict resolution training, divorce, civil, workplace, Jim Melamed, James
Melamed, James C. Melamed, Academy of Family Mediators, SPIDR, law, attorney,
lawyer, bar association, special education, education, conflict resolution
systems"">
<TITLE>The Mediation Center - Guestbook</TITLE>
</HEAD>
<BODY bgcolor="FFFFFF" text="000080" FONT COLOR="000080" 0" link="0000F1" vlink="F76500" alink="C65BF3"">
<TABLE width=590 border=0>
<TR>
<TD width=120 align="center"><IMG SRC="spacer.gif" WIDTH=120 HEIGHT=1></TD>
<TD width=450 align="left"><CENTER>
</CENTER>
<CENTER>
<H1>
<FONT COLOR="800040"><FONT COLOR="008080"><FONT face="arial,helvetica">TMC
Information / Comments</FONT></FONT><BR>
<I><FONT COLOR="000080"></FONT></I></FONT>
</H1>
</CENTER>
<P>
<P>
<FORM action="---www.continet.com/cgi-win/polyform.exe/toagreeguest" method="POST">
<INPUT TYPE="hidden" name="confirmURL" value="---www.to-agree.com/thank.htm">
<BR>
<P>
<TABLE width=530 border=0>
<TR>
<TD width=80 align="left" valign="top"><FONT size=+1>First Name</FONT></TD>
<TD width=100 align="left" valign="top">
<INPUT type="text" name="FirstName" size="25" maxlength="20"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Middle Initial</FONT></TD>
<TD >
<INPUT type="text" name="MI" size="2" maxlength="1"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Last Name</FONT></TD>
<TD >
<INPUT type="text" name="LastName" size="25" maxlength="25"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Business Name</FONT></TD>
<TD >
<INPUT type="text" name="BusinessName" size="25" maxlength="30"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Street / P.O. Box</FONT></TD>
<TD >
<INPUT type="text" name="Street" size="25" maxlength="35"></TD>
</TR>
<TR>
<TD ><FONT size=+1>City</FONT></TD>
<TD >
<INPUT type="text" name="City" size="25" maxlength="25"></TD>
</TR>
<TR>
<TD ><FONT size=+1>State / Province</FONT></TD>
<TD >
<INPUT type="text" name="State" size="2" maxlength="2"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Zip / Postal Code</FONT></TD>
<TD >
<INPUT type="text" name="Zip / Postal Code" size="10" maxlength="15"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Phone</FONT> <I>123-456-7890</I></TD>
<TD >
<INPUT type="text" name="Phone" size="15" maxlength="15"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Fax</FONT></TD>
<TD >
<INPUT type="text" name="Fax" size="15" maxlength="15"></TD>
</TR>
<TR>
<TD ><FONT size=+1>email</FONT></TD>
<TD >
<INPUT type="text" name="email" size="25" maxlength="35"></TD>
</TR>
<TR>
<TD ><FONT size=+1>Web Site URL</FONT></TD>
<TD >
<INPUT type="text" name="Web" size="25" maxlength="50"></TD>
</TR>
<TR>
<TD><FONT size=+1><FONT COLOR="800040"><I><FONT COLOR="000080">I am interested
in:</FONT></I></FONT></FONT><BR>
<P>
</TD>
<TD>
<INPUT type="checkbox" name="type" value="Full Training and Resource Info"><B>Full
Training and Resource Information</B><BR>
<INPUT type="checkbox" name="type" value="Full Training Info"><B>Full Mediation
Training Information</B><BR>
<INPUT type="checkbox" name="type" value="Full Resource Info"><B>Full Mediation
Resource Information</B><BR>
<INPUT type="checkbox" name="type" value="Divorce Mediation Training Information"
><B>Divorce Mediation Training</B><BR>
<INPUT type="checkbox" name="type" value="Civil & Workplace Mediation Training Information"
><B>Civil & Workplace Mediation Training</B><BR>
<INPUT type="checkbox" name="type" value="Advanced Mediation Training Information"
><B>Advanced Mediation Training</B><BR>
<INPUT type="checkbox" name="type" value="Collaboration and Conflict Resolution in Education"
><B>Collaboration and Conflict Resolution in Education</B><BR>
<INPUT type="checkbox" name="type" value="Special Education Mediation Training Information"
><B>Special Education Mediation Training</B><BR>
<INPUT type="checkbox" name="type" value="Mediation Services" ><B>Mediation
Services with Jim Melamed</B><BR>
<INPUT type="checkbox" name="type" value="Online Mediation and Facilitation Services"
><B>Online Mediation and Facilitation Services</B><BR>
<INPUT type="checkbox" name="type" value="Other" ><B>Other (please comment
below)</B>
<P>
</TD>
</TR>
<TR>
<TD><BR>
<BR>
<P>
<FONT size=+1><FONT COLOR="800040"><I><FONT COLOR="000080">Comments:</FONT></I></FONT></FONT></TD>
<TD><TEXTAREA NAME="comments" ROWS="6" COLS="35" wrap></TEXTAREA></TD>
</TR>
</TABLE>
<P>
<BR>
<CENTER>
<B>
<INPUT type=submit value="Submit Request or Comment">
<INPUT type=reset value="Reset"></B>
</CENTER>
</FORM>
</TD>
</TR>
<TR VALIGN="top" ALIGN="left">
<TD HEIGHT =25></TD>
<TD></TD>
</TR>
</TABLE>
<P>
<TABLE width=590 border=0>
<TR>
<TD width=120 align="center"><IMG SRC="spacer.gif" WIDTH=120 HEIGHT=1></TD>
<TD width=450 align="left"><P>
<CENTER>
<H4>
<FONT COLOR="#000080"><FONT COLOR="800000"><FONT face="arial,helvetica">The
Mediation Center, Inc.<BR>
440 East Broadway, Suite 340<BR>
Eugene, OR 97401<BR>
(541) 345-1456<BR>
FAX: (541) 345-4024</FONT><BR>
</FONT> </FONT>
<ADDRESS>
<B>agree@to-agree.com</B>
</ADDRESS>
<ADDRESS>
<B>jmelamed@mediate.com</B>
<P>
<P>