Drawing on the Cervero and Wilson theory of program planning as the negotiation of interests, the purpose of this study was to examine the utility of the distinction between meta-negotiation and substantive negotiation. A case study approach was used to examine a continuing education course in public health. Historically, the course had represented an attempt to implement federal immunization policy. After the course was underway, stakeholders whose interests were not being fully met engaged in meta-negotiations to change the power relationships at the planning table and in substantive negotiations to change the content of the course and audience for it. The redesign and implementation of the course represented a recurring series of substantive negotiations of personal, organizational, and societal interests within relations of power and meta-negotiations about the power relations themselves as stakeholders sought to have their interests represented at the planning table.