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Empanelment
Home / Empanelment
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Name
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First
Last
Email
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Title
*
Mr, Ms, Mrs, Dr., Prof, etc
Gender
*
Male
Female
Phone
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Date of Birth
*
Address
Address Line 1
Address Line 2
City
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
CIArb Member Number
*
Area of expertise in your current profession
*
This will be used to assess your viability for sector specific disputes
Please check the courses you have taken under the CIArb Pathways training
*
Entry Course
Module 1
Module 2
Module 3
Peer Interview
Arbitration
Arbitration Entry Course
Arbitration Module 1
Arbitration Module 2
Arbitration Module 3
Arbitration Peer Interview
Mediation
Mediation Entry Course
Mediation Module 1
Mediation Module 2
Mediation Module 3
Mediation Peer Interview
Construction Adjudication
Construction Adjudication Entry Course
Construction Adjudication Module 1
Construction Adjudication Module 2
Construction Adjudication Module 3
Construction Adjudication Peer Interview
Entry Course
Module 1
Module 2
Module 3
Peer Interview
Kindly give the date of when you qualified for the most recent course
*
Have you completed your Mentorship Program
*
Yes
No
If No, please note you are not eligible to make the application
Mentor Information
Please confirm when you took the Mandatory Induction Training
*
Please confirm whether you are a paid up member
*
Yes
No
Give a brief bio that will be used to introduce you to potential clients.
*
Consent
*
I confirm that the information submitted herein is correct and true
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