ICMTA Witnessing & Mediation Service

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ICMTA Witnessing & Mediation Service - APPLICATION FORM V1.1

Name *

ICMTA membership number: *

Country *

Spoken language(s): *

Are you comfortable enough with the English language to be able to go through this process in English? If not, what is your preferred language? *

Please agree to the following statement:

I have read and understood both the ICMTA Witnessing & Mediation Service V1.1 and the ICMTA Witnessing & Mediation Service - Boundaries of Service V1.1 *

Yes

Required

Can you describe the problem you experience right now? *

What reasonable attempts have you made to resolve the situation directly by accessing your own networks & resources? *

What help was provided? *

What actions were taken? *

What help do you need right now? *

What outcome do you want to result from this process?

Thank you for submitting the ICMTA Witnessing & Mediation Service Application Form.

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