[{"type":"header","subtype":"h3","label":"PANEL MEMBER","access":false},{"type":"paragraph","subtype":"p","label":"All ANM panel members must be  CMC Registered Mediators. This form is for accredited practicing mediators who have completed the training and practice requirements set by the Civil Mediation Council, registered with CMC as a mediator and based in the North of England.<div>If this does not apply to you, please do not complete this form and return to the sign up page.</div>","access":false},{"type":"text","required":true,"label":"Full Name","className":"form-control required","name":"full_name","access":false,"subtype":"text"},{"type":"text","required":false,"label":"Business Name ","className":"form-control","name":"text-1678199684640","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Address","className":"form-control required","name":"address","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Postcode","className":"form-control required","name":"postcode","access":false,"subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email","className":"form-control required","name":"email","access":false},{"type":"text","required":true,"label":"Preferred Contact Telephone No.","className":"form-control required","name":"phone","access":false,"subtype":"text"},{"type":"text","required":false,"label":"Website","className":"form-control","name":"website","access":false,"subtype":"text"},{"type":"textarea","required":true,"label":" Additional professional qualifications relevant to the type of mediation you practise eg medical, legal etc (mediation qualifications are entered  further on)","className":"form-control required","name":"qualifications","access":false,"subtype":"textarea"}]

[{"type":"header","subtype":"h3","label":"Mediation Training","access":false},{"type":"paragraph","subtype":"p","label":"<div>Details of Civil & Commercial Mediation Training</div><div><br></div><div>Note that the minimal required length of any training course is 40 hours and the course itself must be one that is recognised as meeting the current standards for Civil Mediators identified by the Civil Mediation Council (known as the ‘CMC’).</div><div><br></div><div>It is a prerequisite that all those organisations recognised as training mediators provide courses of at least four days or 40 CPD hours.</div>","access":false},{"type":"text","required":true,"label":"Details of your Civil and Commercial Training Provider including date of training","className":"form-control required","name":"training_providers","access":false,"subtype":"text"},{"type":"text","required":false,"label":"Details of any other mediation training completed (Title of training, length, date and  name of provider)","className":"form-control","name":"text-1678201842441","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"ANM panel members must be registered as mediators with the CMC. If you are NOT a registered mediator with CMC but are on the pathway and require observations, please complete the Potential Panel form, NOT this one!","access":false},{"type":"radio-group","required":true,"label":"Which of the following best describes you? If you require observations to register with CMC please DO NOT complete this form, complete the potential panel form.","inline":false,"className":"required","name":"radio-group-1684771028371-0","access":false,"other":false,"values":[{"label":"An accredited practicing mediator","value":"option-1","selected":false},{"label":"Registered with CMC but would like to co-mediate or observe","value":"option-2","selected":false}]},{"type":"radio-group","required":true,"label":"Please indicate what your membership status is with the Civil Mediation Council.<div>To be approved for the ANM panel you must be a CMC Registered Mediator or CMC Fellow. See https://civilmediation.org/membership/</div>","inline":false,"className":"form-control required","name":"radio-group-1678099612369","access":false,"other":false,"values":[{"label":"CMC Registered Mediator","value":"Registered","selected":false},{"label":"CMC Fellow","value":"Fellow","selected":false}]},{"type":"text","required":false,"label":"Date of CMC registration, last renewal or CMC number (any format)","className":"form-control required","name":"text-1683732358878-0","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"Dispute Resolution Experience","access":false},{"type":"checkbox-group","required":true,"label":"Areas of Mediation<div>When you are approved for panel membership, we list you for up to 5 areas of experience. Please choose at least one category to appear on search.  If more than 5 named, first five ticked will be shown</div><div>Please select by ticking the areas in which you have expertise. </div>","toggle":false,"inline":false,"className":"required","name":"checkbox-group-1683736545310-0","access":false,"other":false,"values":[{"label":"Agriculture","value":"agriculture","selected":false},{"label":"Banking & Finance","value":"banking-financial-services","selected":false},{"label":"Construction & Engineering","value":"construction-engineering","selected":false},{"label":"Contractual Disputes","value":"contractual-disputes","selected":false},{"label":"Employment & Workplace","value":"employment-including-workplace","selected":false},{"label":"Media & Communications","value":"media-communications","selected":false},{"label":"Partnership","value":"partnership-shareholder-disputes","selected":false},{"label":"Personal Injury & Medical Negligence","value":"personal-injury-medical-negligence","selected":false},{"label":"Professional Negligence","value":"professional-negligence-claims","selected":false},{"label":"Property","value":"property","selected":false},{"label":"Small Claims","value":"small-claims","selected":false},{"label":"Trust Wills & Probate","value":"trusts-wills-probate","selected":false}]},{"type":"text","required":true,"label":"During the last 12 months have any complaints been made about your mediation practice? Details if any or type in none if it doesn't apply:","className":"form-control required","name":"any_complaints_made","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Names of any other mediation, arbitration, adjudication or conciliation panels to which you belong or any other dispute resolution roles you are currently involved in.<div>type in none if not applicable:</div>","className":"form-control required","name":"set_out_details_arbitration","access":false,"subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div> Only mediators who have completed all the observation and experience points for CMC registration and are currently CMC Registered Mediators will be approved for the ANM panel.<br></div>","access":false}]

[{"type":"header","subtype":"h3","label":"Annual Continuous Professional Development Requirement","access":false},{"type":"paragraph","subtype":"p","label":"<div>This is a mandatory requirement for ALL applicants for panel membership.</div><div><br></div><div>The Association has an annual requirement that all panel members carry out at least 6 hours CPD training in any one calendar year. Newly qualified members can use their initial training to fulfil this commitment providing this was done within the previous 18 months or such further period as we determine if circumstances justify a longer period.</div><div>This should be made up so far as possible with structured mediation specific training. To make it easier to complete the details we would ask you to complete the brief confirmation.<br></div><div>Note that the ANM provides an online CPD programme and prerecorded sessions may be accessed in the members area.</div><div><br></div><div> If you have not done the 6-hour minimum then please set out the extenuating circumstances in the following space to include other mediation endeavours eg relevant committee work or involvement with mediation provider or personal circumstances justifying our carrying over the requirement into the next year. Time can only be carried forward once.</div>","access":false},{"type":"radio-group","required":true,"label":"Have you carried out at least 6 hours of CPD training within the last year?","inline":false,"className":"form-control required","name":"carried_out_cpd_training","access":false,"other":false,"values":[{"label":"Yes","value":"yes","selected":false},{"label":"No","value":"no","selected":false}]}]

[{"type":"header","subtype":"h3","label":"CPD Training Record","access":false},{"type":"text","required":true,"label":"If you have not completed the required training commitment, please set out below the time spent doing mediation activities. These include assisting in demo mediations and mediation awareness workshops. Please include the activity, date and hours. Alternatively, if you have not spent time doing any mediation activities, please describe the circumstances justifying waiving or carrying forward the commitment. Note that ANM will only exercise discretion in exceptional circumstances such as absences due to working abroad, illness or maternity:","className":"form-control required","name":"required_training_commitment","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"Professional Indemnity Insurance","access":false},{"type":"paragraph","subtype":"p","label":"<div>It is a requirement of all mediators practicing as panel members to comply with the minimum requirements for insurance cover identified by the CMC. This is currently £1,000,000.</div><div><br></div><div>Please confirm that you hold PI insurance of at least the above to cover your acting as a Mediator in civil and commercial mediations, and that you undertake only to take on mediations that come within the scope of your cover.</div>","access":false},{"type":"text","required":true,"label":"Name of your Insurance provider:","className":"form-control required","name":"insurance_provider","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Your insurance policy number:","className":"form-control required","name":"insurance_policy_number","access":false,"subtype":"text"}]

[{"type":"header","subtype":"h3","label":"Adherence to EU Code of Conduct for Mediators","access":false},{"type":"paragraph","subtype":"p","label":"<div>By applying to join ANM and, if accepted as a member, you agree to be bound both by the terms and conditions of its constitution and to the European Code of Conduct. For more information please visit: -</div><div><br></div><div>https://www.euromed-justice.eu/en/system/files/20090128130552_adr_ec_code_conduct_en.pdf</div>","access":false}]

[{"type":"header","subtype":"h3","label":"Signature","access":false},{"type":"paragraph","subtype":"p","label":"<div>By submitting this application you agree to: -</div><div>-continuing your CMC registration and notifying ANM if you are no longer registered with the CMC</div><div>- accept such monitoring and evaluation of mediations carried out by you as the Association may from time to time require,</div><div>- maintain a logbook of mediations,</div><div>- comply with the CPD requirements </div>- include within your terms and conditions details of the Association’s or CMC complaints procedure.<div>I confirm by signing below (digital accepted) that the above information is correct and that I also confirm adherence to ANM’s obligations under both the Data Processing Act 1996 and the General Data Protection Regulations 2017 that all data provided by or on behalf of ANM shall be used strictly for the purposes for which it is provided. </div>","access":false},{"type":"text","required":true,"label":"Signed:","className":"form-control required","name":"signed","access":false,"subtype":"text"},{"type":"text","required":true,"label":"Date","className":"form-control required","name":"date","access":false,"subtype":"text"}]