With extensive experience in the management and resolution of building and construction disputes, the BDTSA is fast becoming is fast becoming a recognised and respected entity.

The BDTSA provides nationwide services to the building and construction industry as well as members of the general public.
Follow Us On Social

Mediators Application Form

Mediators Submission Form

Welcome to the BDTSA mediators application for inclusion as mediator on the BDTSA panel

Please note that application to be on the BDTSA panel of mediators are free of charge and there are no subscriptions payable to be on the panel. All information contained in this application is treated as confidential and private and will not be disclosed to any third party.

Completion of this application form does not in itself guarantee or create any expectation of any mediation work from the BDTSA or their affiliates and inclusion to the BDSTA panel is subject to the discretion of the BDTSA and subject to approval.

Personal details of applicant

Title
  • - select your title -
  • Mr
  • Mrs
  • Miss
  • Adv
  • Dr
  • Prof
- select your title -
Field is required!
Field is required!
Full name(s)*
Your Full Name(s)
Field is required!
Field is required!
Last name*
Your Last Name
Field is required!
Field is required!
Gender
Field is required!
Field is required!
ID number*
ID number
Field is required!
Field is required!
Nationality
Nationality
Field is required!
Field is required!
First language*
First language
Field is required!
Field is required!
Other languages
Other languages
Field is required!
Field is required!
Physical address*
Your Physical Address
Field is required!
Field is required!
Town*
Town
Field is required!
Field is required!
Postal code
Postal code
Field is required!
Field is required!
Postal address*
Postal address
Field is required!
Field is required!
Town*
Town
Field is required!
Field is required!
Postal code
Postal code
Field is required!
Field is required!
Phone during office hours*
Phone during office hours
Field is required!
Field is required!
Phone after hours*
Phone after hours
Field is required!
Field is required!
Mobile phone*
Mobile phone
Field is required!
Field is required!
Email address*
Your E-mail Address
Field is required!
Field is required!
Alternative email address
Alternative email address
Field is required!
Field is required!

Professional profile

Name of current employer
Name of current employer
Field is required!
Field is required!
Work contact number*
Work contact number
Field is required!
Field is required!
Employers type of business*
Employers type of business (if applicable):
Field is required!
Field is required!
Your primary profession*
Your primary profession
Field is required!
Field is required!
Years of practice (in the event of legal professionals)
Field is required!
Field is required!
Types of mediation preferred*
Please select at least one
Please select at least one
File Upload: Please attach a clear colour photo (head and shoulders) in JPEG format for publication on our website.
Upload your photo
Field is required!
Field is required!

Qualifications & accreditation

Give us a short description of your mediation experience and below indicate your qualifications / accreditation*
Give us a short description of your mediation experience
Field is required!
Field is required!
Institution*
Institution
Field is required!
Field is required!
Institution
Institution
Field is required!
Field is required!
Institution
Institution
Field is required!
Field is required!
Institution
Institution
Field is required!
Field is required!
Qualification / achievement*
Qualification / achievement
Field is required!
Field is required!
Qualification / achievement
Qualification / achievement
Field is required!
Field is required!
Qualification / achievement
Qualification / achievement
Field is required!
Field is required!
Qualification / achievement
Qualification / achievement
Field is required!
Field is required!
Year obtained*
Year obtained
Field is required!
Field is required!
Year obtained
Year obtained
Field is required!
Field is required!
Year obtained
Year obtained
Field is required!
Field is required!
Year obtained
Year obtained
Field is required!
Field is required!
Please upload a copy of your most relevant qualification / accreditation (specifically your mediation training)*
Upload
Field is required!
Field is required!
Please upload a copy of any other relevant qualification / accreditation
Upload
Field is required!
Field is required!
How many times per month do you engage in mediation (days)
Field is required!
Field is required!

Fee structure & area

Fees are always a sensitive issue. Depending on your field of expertise, experience and exposure to mediation, fees structures will differ from mediator to mediator. Below is an indication of your maximum and minimum fees that you charge - this serves as a guideline for clients.

This is only a guideline as the full details of fees, disbursements etc. will be negotiated before the mediation are conducted.

Hourly fee (minimum per hour)
Minimum
Field is required!
Field is required!
Hourly fee (maximum per hour)
Maximum
Field is required!
Field is required!
Daily fee (minimum per day)
Minimum
Field is required!
Field is required!
Daily fee (maximum per day)
Maximum
Field is required!
Field is required!
Inclusive price of full mediation (regardless of number of sessions)
Estimated price
Field is required!
Field is required!
Geographical area that you could maintain as mediator*
Field is required!
Field is required!
Please list the town(s) where you are prepared to act as mediator*
Please list the town(s) where you are prepared to act as mediator
Field is required!
Field is required!

Declaration & confirmation

Please indicate your commitment by checking all the boxes below
Field is required!
Field is required!
By affixing your signature you agree to the above
Please sign
Please sign