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Membership Application Form

Please complete all required fields!

1. PERSONAL INFORMATION

Surname(*)

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Initials(*)

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Title(*)

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First name(*)

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Identity (RSA) or passport number (non-RSA citizens) (*)

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Date of Birth(*)

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Gender(*)

Male
Female
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Occupation

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Language(s)

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Do you have a disability

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Nature of your disability

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2. BUSINESS PARTICULARS

Postal address (*)

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Business address

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Cell(*)

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Landline

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Website

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E- mail address(*)

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Invoice address (Including Vat number if applicable)

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3. MEMBERSHIP OF PROFESSIONAL ORGANSATIONS

Name of organisation

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Telephone number

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Position held

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Time period

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4. MEDIATION TRAINING

Training institution

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Year(*)

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Which field(s) are you trained to mediate in?(*)

Family and Divorce
Civil Commercial
Labour
Restorative Justice select field of mediate

Are you an accredited Court Annexed Mediator

Yes No Invalid Input

Level

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6. INTEGRITY

6.1 Are there any circumstances, financial or otherwise, known to you which may cause you embarrassment in being appointed as a mediator ? State

Yes No Invalid Input

If yes, provide detail

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6.2 Have you ever been convicted of any crime or offence involving dishonesty, violence, or any other disreputable, dishonorable conduct? State

Yes No Invalid Input

If yes, provide detail

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6.3 Has any professional body ever found you guilty of any unprofessional conduct? State

Yes No Invalid Input

If yes, provide detail

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9.4 Do you suffer from a mental illness or a severe or profound intellectual disability in terms of the Mental Health Act (Act 17 of 2002)? State

Yes No Invalid Input

If yes, provide detail

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9.5 Is there any other relevant information which you should bring under the attention of Social Justice Association of Mediators? State

Yes No Invalid Input

If yes, provide detail

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I, the undersigned, confirm that the information contained in this form is true and correct. I hereby
accept the Code of practice and Constitution of Social Justice Foundation Association of Mediators.

Please choose your membership benefits option

1 - Pay as you Go
2 - Membership & 5 CPD Training Certificates-10 months-R146 monthly
3 - Membership & 5 CPD Training Certificates-12 months-R125 monthly
4 - Membership & 8 CPD Training Certificates & Accreditation-10 months-R217 monthly
5 - Membership & 8 CPD Training Certificates & Accreditation-12 months-R189 monthly
6 - Membership & 5 CPD Training Certificates & 2-Day Conference & Accreditation-10 months- R357 monthly
7 - Membership & 5 CPD Training Certificates & 2-Day Conference & Accreditation-12 months- R299 monthly Invalid Input

Signature(*)

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Date(*)

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Checklist of Documents required for application as a Member

Checklist of Documents required for application as a Member

1. Application form duly completed
2. Certified copy of ID or drivers license
3. Proof of mediation training attended
4. Proof of professional qualification(s)
5. Proof of professional membership card or letter (if applicable)
6. Proof of student registration (if applicable)
7.CV – (excluding your mediation training and experience)

a. Year of matriculation, province, school
b. Tertiary education
c. Work experience
d. Membership of professional organisation’s.
e. Mediation Training
8. Affidavit (as per the template)
9. Annual Accreditation Certificates/ letter from membership organisation confirmation your years of being an accredited mediator (if applicable).

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NOTE: All copies of documents must be certified copies.

Print name

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Signature:(*)

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reCAPTCHA(*)

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new logo 2

Address

HEAD OFFICE
First Floor, Riesling House, The Vineyard Office Estate, 99 Jip de Jager Drive, De Bron, Cape Town
POSTAL ADDRESS
P O Box 4846, Tygervalley,7536

About Social Justice NPO (165-067NPO)

Social Justice Association of Mediators is a Non-profit Organisation with its head quarters in Cape Town, incorporated in terms of the laws of the Republic of SA. It renders a variety of services to members of the public and government departments. It functions with various cost centres, including the membership organisation structure with a subcommittee as its board for the benefit of its members. The organisation is managed by its Board of Executive members and co-opted members.

Payments

Social Justice Foundation NPO

FNB Account number:
62745396277
Branch Code:
252645 Menlyn Park

Contact Us

General Enquiries: admin@socialjustice.org.za
Landline 021 300 6309
MediationServices
and Training Enquiries
Tel 064 800 3975

Our Processes

Social Justice NPO is home to like-minded individuals with a shared vision and mission to address inequalities in society, various social justice issues by promoting access to justice, restoring justice to a deeply divided society, the rendering access to justice through alternative dispute resolution including mediation, restorative justice & peacemaking and the empowering individuals & communities through education and training.

Social Justice NPO (165-067NPO) provides this website as a service to the public and website owners. Social Justice NPO (165-067NPO) is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on any information contained within the site. While the information contained within the site is periodically updated, no guarantee is given that the information provided in this website is correct, complete and up-to-date.

Although the Social Justice NPO (165-067NPO) website may include links providing direct access to other internet resources, including websites, Social Justice NPO (165-067NPO) is not responsible for the accuracy or content of information contained in these sites. Links from Social Justice NPO (165-067NPO) to third party sites do not constitute an endorsement by Social Justice, and Social Justice has not investigated the claims made by any advertiser. Product information is based solely on material received from suppliers.

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home
About us
Why Mediate?
Mediators
CPD Events
Find a Mediator
Contact Us
- Social Justice Blog
- News Room
more...