Mediator Registration

As of November 30, 2018 the West Virginia State Bar ADR Committee will transition its current “Mediator Listing” to a new tracking system. Renewal is on an annual basis. By completing the following form you are attesting that you meet the Meditor Requirements.

Mediator

Membership *

Volunteer Mediator Only - $ 0.00

Paid Mediator Only - Listed in 5 Counties - $ 50.00

Paid Mediator Only - Listed in 10 Counties - $ 100.00

Paid and Volunteer Mediator - Listed in 5 Counties - $ 50.00

Paid and Volunteer Mediator - Listed in 10 Counties - $ 100.00

Total Amount

Email Address *

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *