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APPLY TO BE LISTED AS AN ADR PROFESSIONAL

CFDR is pleased to offer an online application for listings in ADR·Connect. Listing is offered at a nominal fee that allows us to recover the costs of maintaining and promoting this unique service. You can complete this ADR·Connect Application Form on-line to apply for listing as an ADR professional in one or more of four categories. When you have completed the application on-line, simply use the "Submit your Application" button on the bottom of the form.

Please read the terms in Part 6 -Terms of Agreement carefully. Listing is contingent on agreement to abide by these terms. We will enter your information into our database and return a printout of your record along with a copy of Part 6 (the terms of agreement). Please review the printout of your record for accuracy, mark any necessary changes, sign Part 6 (the terms of agreement), and return it along with your payment to:

The Canadian Foundation for Dispute Resolution
12075, 237 Fourth Avenue S.W., Calgary, Alberta T2P 0H6.

We will activate your file on the website when payment and the signed agreement are received.

You may request and complete a paper copy of this application. However, because this increases our administrative costs, a $50.00 handling charge will be added to each listing fee.

PART 1
Request for Listing

I request listing in ADR-Connect as a:

Mediator Abitrator ADR Lawyer Systems Designer

The Fee for this listing is:

	Non-Member	Member
ADR Neutral (mediator and/or arbitrator) (gst included)	@$267.50/year	@$214.00/year
ADR Lawyer (gst included)	@$267.50/year	@$214.00/year
ADR Systems Designer (gst included)	@$267.50/year	@$214.00/year
Total	$	$
Note: All individuals in companies that are current members of the Foundation are entitled to a 20% discount on their first listing and a 40% discount on subsequent listings in the other two listing categories

PART 2
General Background

Name:
Last Name
First Name
Middle Name or Initials
Salutation
Designation/Degree
Company or Organization
Address:
Office / Suite Number
Address
City
Province/State
Country
Postal Code
Communications:
Telephone
Fax
E-Mail
Web Site
ADR Designation:
Chartered Arbitrator (C.Arb)
Chartered Mediator (C.Med.)
Fellow, Chartered Institute of Arbitrators (FCIArb)
Associate, Chartered Institute of Arbitrators (ACIArb)
LL.M. - ADR
Language Proficiency:
English French
Other Languages

Subject Matter Experience:

Aboriginal Law
Administrative Law
Agriculture
Architecture
Aviation and Air Law
Banking and Finance
Bankruptcy and Insolvency
Building Contracts
Conflict of Laws
Construction
Contract Law
Copyright
Corporate and Commercial
Debtor and Creditor
Education
Employment Law
Engineering
Environmental
Estates
Fiduciary Duty
Forestry
Information Technology
Insurance
Intellectual Property
International Law
Labour Law
Landlord and Tenant
Manufacturing
Media
Mines and Minerals
Motor Vehicle Accidents
Natural Gas Pricing
Oil and Gas
Patents and Inventions
Personal Injury (other than motor vehicle)
Pipelines
Planning and Zoning
Products Liability
Professional Negligence
Public Utilities
Receivers
Securities
Sports
Taxation
Telecommunications
Trademarks and Industrial Design
Transportation
Other

Membership in ADR Organizations:

Organization	Member Since (yyyy)

Post Secondary Education:

Year	Institution	City	Study Area	Degree

Significant Mediation Training Courses

Year	Course Name	Institution	Hours

Significant Arbitration Training Courses

Year	Course Name	Institution	Hours

Significant Y2K Preparation
(Indicate whether you have had any special training in Year 2000 technical and legal issues.)

The Canadian Foundation for Dispute Resolution Millennium Accord and Y2K Capability Development.

Yes No

Other Y2K Training/Conferences

Name	Institution	Month	Year

PART 3:
ADR Neutral Information
(Please complete only if you are requesting listing as an Arbitrator and/or Mediator.)

ADR Capability and Experience
(Indicate those ADR processes in which you have capability and experience as an ADR neutral. Include years of experience and approximate numbers of cases for each ADR process.)

	Commercial Mediation	Other Mediation	Commercial Arbitration	Other Arbitration
Years Experience	Under 5 5 to 10 Over 10	Under 5 5 to 10 Over 10	Under 5 5 to 10 Over 10	Under 5 5 to 10 Over 10
Cases	Under 10 10 to 20 Over 20	Under 10 10 to 20 Over 20	Under 10 10 to 20 Over 20	Under 10 10 to 20 Over 20

Have you ever been a Mediator or Arbitrator in a complex commercial dispute? (A complex commercial dispute is a dispute with complicated legal, factual, and/or technical issues)

Mediator	Arbitrator
No cases Under 5 cases 5 to 10 cases Over 10 cases	No cases Under 5 cases 5 to 10 cases Over 10 cases
Have you ever been a Mediator in a court-connected mediation?
No cases Under 5 cases 5 to 10 cases Over 10 cases

ADR Roster Information:
(Indicate whether you are on the roster of any of the following:)

ADR Organization	Yes	No
The Canadian Foundation for Dispute Resolution Third Party Neutral Panel
Ontario Mandatory Mediation Program Roster
ADR Chambers
Arbitration and Mediation Institute of Canada (or provincial affiliate)
British Columbia International Commercial Arbitration Centre
The Quebec National and International Commercial Arbitration Centre
CPR Institute for Dispute Resolution
Other Organizations

Other Mediation Information:
(Include other information you believe to be relevant to your capability and experience as a mediator. Please write in the third person.)

Other Arbitration Information:
(Include other information you believe to be relevant to your capability and experience as an arbitrator. Please write in the third person.)

Part 4:
ADR Lawyer Information
(Please complete only if you are applying for a listing as a lawyer, to act as legal counsel to parties using ADR for disputes.)

ADR Counsel Capability and Experience: (Indicate those ADR processes in which you have capability and experience in your role as a lawyer acting as counsel for a party. Also, indicate number of years of experience and an approximate number of cases for each ADR process.)

	Commercial Mediation	Other Mediation	Commercial Arbitration	Other Arbitration
Years Experience	Under 5 5 to 10 Over 10	Under 5 5 to 10 Over 10	Under 5 5 to 10 Over 10	Under 5 5 to 10 Over 10
Cases	Under 10 10 to 20 Over 20	Under 10 10 to 20 Over 20	Under 10 10 to 20 Over 20	Under 10 10 to 20 Over 20

Have you ever been a Mediator or Arbitrator in a complex commercial dispute? (A complex commercial dispute is a dispute with complicated legal, factual, and/or technical issues)

No cases
Under 5 cases
5 to 10 cases
Over 10 cases

Other ADR Lawyer Information:
(Include information you believe to be relevant to your capability and experience as a lawyer acting as counsel for parties involved in ADR processes. Please write in the third person.)

Part 5
ADR Systems Design Information
(Please complete only if you are applying for a listing as a systems designer.)

ADR System Design Capability and Experience:
(Indicate your experience as a systems designer.)

Years of Experience:

None
Under 5
5 to 10
Over 10

Systems Consulted on or Designed:

None
Under 5
5 to 10
Over 10

References/Contacts for Systems Design Work: (Include the organizations for which you have done this work, and the names of people who a party may contact for references, with telephone and e-mail addresses, if available)

Organization	Contact Person	Telephone No. (with area code)	E-mail (person@isp.com)

Other ADR Systems Design Information:
(Include other information you believe to be relevant to your capability and experience in ADR systems design, such as particulars of systems design work you have done. Please write in the third person.)

Part 6
Terms of Agreement
(please use the hyperlink above to access the Terms of Agreement)

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