Mediators - Registration Form

MEDIATORS REGISTRATION FORM

REGISTRATION FEES

There is an annual fee for registering in our Mediators Directory. The annual fee is $150.00 Canadian funds. [cheques only accepted - Please send cheques payable to Stephanie Gower]

The fee entitles the registrant to have their name, address, telephone, fax, e-mail and web-site addresses and more displayed (see below). As well, a description or further information (up to 200 words) of the qualifications, services offered, etc. is included. Also, for no extra charge, we will provide a link to your e-mail address and website, if applicable.

Please provide the following information, which will appear in your listing in the Mediators Directory:

NAME:

FIRM OR COMPANY NAME:

ADDRESS:

PHONE:

FAX:

E-MAIL:

WEBSITE:

MEDIATING SINCE:
EDUCATION / QUALIFICATIONS:

LANGUAGES OTHER THAN ENGLISH:

LOCATIONS SERVICED:

AREAS OF INTEREST / EXPERTISE:

ANY ADDITIONAL INFORMATION FOR LISTING (up to 200 words):

Please send cheques payable to Stephanie Gower

Stephanie M. Gower
PO Box 390, Belmont, ON, Canada N0L 1B0
Email: information@litigationresource.com