San Fernando Valley Bar Association

Mediator Directory Online Application

Fields marked with * are required; please make sure to fill in all required fields before submitting the form. To submit a profile, please complete the form below with your credit card information or click here to print and fax/mail a pdf version with your check.
Date:
Name:
Firm Name:
Office Address:
City:
State:
Zip Code:
Phone:
Fax:
*Email Address:
Website Address (URL):
CA State Bar Number:
Admission Date :	Year:
Years in Practice:

Education:
Law School:
Date:	Year:

Mediation Practice Areas:
Select all that apply by holding down the 'ctrl' key


Mediation Training:
Name of Provider Organization (1) :
Date (1) :	Year:
Number of Course Hours (1) :
Name of Provider Organization (2) :
Date (2) :	Year:
Number of Course Hours (2) :
Name of Provider Organization (3) :
Date (3) :	Year:
Number of Course Hours (3) :

Other Training:

Mediation Fees:
Standard Fee:
Administration Fee:
Cancellation Fee:
Other Fees:

Professional Experience (Limit to 100 words):


Membership with Other Dispute Resolution Organizations/Agencies/Panels:
Name of Orginization: (1)
Years Affiliated: (1)
Name of Orginization: (2)
Years Affiliated:(2)
Panels:
.List Additional Organizations/ Agencies/Panels:

Other Professional Organization Memberships:


Special Requirements/Comments About Mediation Procedure:
(Anything you think would be helpful for parties to know)

You May Also Submit A Picture:
We prefer that you submit your picture electronically. Please email your picture to epost@sfvba.org.

Requirements and Affirmations:

I understand that by submitting my profile for inclusion in the online Mediators Directory I am affirming that I have met the following minimum requirements: Active membership in the San Fernando Valley Bar Association; Member in good standing with State Bar of California with a minimum of five years experience as a practicing attorney; Completion of thirty (30) hours of ADR training in a qualified program; Completion of twenty-five (25) mediations of at least two (2) hours in duration; Committed to attending eight (8) hours of Continuing Legal Education, authoring articles, or delivering an oral presentation on ADR-related topics annually; Annual payment of $150; and Maintain an Errors and Omission Professional Liability Insurance Policy. The policy shall provide a minimum of $100,000 per claim/$300,000 aggregate coverage.

By selecting this box I agree to the above.
Note for requests that require payment: Upon submitting this form you will be taken to a secure payment form at our Credit Card processor. Please enter your information and once your payment goes through you will be taken back to the SFVBA website where you can find more information to help you. Please go through ALL the steps in the processing procedure (selecting "Continue" as you go along) and you will be returned to the SFVBA web site. If you encounter any problems, Please send an email to "info@sfvba.org" and explain the nature of your problem.
Payment Method:
*Name on Card:
*Billing Address:
*City:
*State:
*Zip Code:
*Billing Phone: