vamediation.org

Online Registration for VA Mediation Network

2 Ways to Join

  1. Fill out form and pay online, you will be redirected to Paypal's secure server, and can then pay with credit card or Paypal account.
  2. Fill out form then click print & mail in. Your form will print and you can mail that with your check to: VMN 3720 Parchment Circle Richmond, VA 23233

Questions? Please contact the office at 804-254-2666 and office@vamediation.org for any problems or questions. Thank you for your registration.

Name & Address

First Name:
Last Name:
Middle Name:
E-mail:  
Address:
City:
State:
Zip:
Phone:
Website:

Business Information

Virginia Supreme Court Dispute Resolution Approved Mentor? YES         NO  
Certification:  (Please check all that apply)
  General District Court 
 Circuit Court - Civil
  J&DR District Court
  Circuit Court - Family 
 
Are you an attorney? YES         NO  
How many mediators and/or attorneys are in your firm?  

Membership Information

Please select one:
   Basic Membership $125 
   Student Membership $50
   Enhanced Membership $175

More Information

Submit &Pay

Total Enclosed

 $ for