Lacefield & Associates Mediator Network Questionnaire

Terms and Conditions of Lacefield & Associates National Mediator Network:

  • 1st year free
  • 2nd year $50 fee to maintain/update information
  • Billing for mediations will be conducted through Lacefield & Associates. A 15% referral fee will be subtracted from the total due from the parties for all mediations made through the referral network.
  • Within 30 days of profile submission, verification of all certifications listed on the mediator’s profile are due to Lacefield & Associates via fax transmittal or regular mail. This is necessary for all mediators, including those who have received certification through Lacefield & Associates.

Please complete the following form if you are interested in joining the Lacefield Mediation Network.

First Name:
Last Name:
E-mail Address:
Primary Phone Number:
- -
City
State
What is your Web Site URL?
What is your hourly rate for mediation services?
Areas Of Practice- What areas of practice are you qualified to mediate:
Professional Background- Describe your professional experience and qualifications:
Mediation Experience- Describe your experience as a mediator:
Training- List any mediation courses, seminars and continuing education related to mediation:
Education- List college & university attendance:
Upload a photo of yourself:


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