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HPCMS
Mediators' Booking Form

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Full Name

Email:

Phone:

Why are you applying for this role?

What is your current occupation? (Please briefly describe your responsibilities).

Are you an Accredited Mediator?

Did you qualify with ADR ODR International?

Please provide the date (month & year) and country of the course you did with us.

If applicable, which other provider did you qualify with and when? (We will only accept our graduates for this Scheme)

Have you completed the ODR training with us? (Candidates w/o ODR training will not be considered).

Date on your ADR ODR International ODR e-certificate.

Are you listed on ADR ODR International's Panel Membership? (Candidates not on the Panel will not be considered).

Month and year of when you enrolled onto the Panel Membership.

I consent to ADR ODR International retaining and storing the data supplied in this form.

I consent to ADR ODR Int taking, retaining & using any images of me during the training course for marketing.

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