ADRBC Application for Membership

PART 1 - APPLICANT INFORMATION

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* 1. Legal First Name

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* 2. Legal Last Name

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* 3. Preferred First Name

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* 4. Contact Information

Street Address *

Unit or Apt #

City/Town *

Province *

Postal Code *

Email Address *

Phone Number *

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* 5. Employment Information

Profession *

Company *

If retired, profession prior to retirement

Part 2 - APPLICATION QUESTIONS:

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* 6. Are you interested in

Arbitration

Mediation

Both

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* 7. Are you currently practicing ADR?

Yes

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* 8. Are you interested in applying for Roster Status (if applicable)?

Yes

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* 9. Are you interested in our Education Programs?

Yes - As a Student

Yes - As a Coach or Trainer

All of the above

None of the above

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* 10. Would you be interested in participating in our Mentorship Program?

Yes - As a Mentee

Yes - As a Mentor

Not at this time

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* 11. If you answered 'Yes' and are interested in becoming a Mentor or Instructor, please include a brief resume of your credentials:

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* 12. Please share any other details regarding your interest in become a Member with ADRBC. We love hearing from you!

Part 3 - APPLICANT DECLARATION

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* 13. By filling in the boxes below, I agree, once accepted as a Member of ADRBC/ADRIC, to be bound by their by-laws and/or regulations made, the terms of their constitution and by any subsequent amendments and/or alterations thereto which may be made.

Applicant Initials

Date Submitted

Thank you for your interest in joining us at ADRBC/ADRIC.
A member of our staff will be reviewing your application, and will be in touch with you soon.

If you have not heard from anybody within 7-10 business days, please email us at: info@adrbc.com

With appreciation,
The ADRBC Team