<p> MII Member Assessment Application Form </p><p>Note: To attend for MII Member assessment you must be a registered Associate Affiliate</p><p>Name (please print):</p><p>Address:</p><p>Tel: Mobile: </p><p>Email1:</p><p>1 All MII communications are by email (except for election materials). The onus is on the member to ensure that the MII has their correct current email address.</p><p>Please Indicate Area of Practice: Please tick the appropriate box(s) and/or specify other area of practice: </p><p>Agriculture □ Civil and Commercial □ Community □ Construction □ Elder Mediation □ Environment □ *Family □ Healthcare □ Insurance □ Organisational/Workplace □ Professional Negligence □ Restorative Justice □ Separating Couples □ Other (please specify):</p><p>*Family denotes interfamily disputes (e.g. sibling; parent/adult child etc.) other than separating couples.</p><p>Please ensure that the following are included with your assessment form: Assessment fee of €275.00/St£230.00 □ Completed Member Assessment Application Form □ Note: Fee may be paid in either Euro or Sterling.</p><p>Please indicate preferred dates for Assessment: </p><p>Note: 1. Assessments will be held in Dublin and are open to registered MII Associate Affliates. 2. Places will be allocated on a first-come, first-served basis. 3. Please refer to the MII website for full details of the assessment process: http://www.themii.ie/membership 4. The MII will notify applicants as soon as possible in the unlikely event of a change to dates for Member status assessments. </p><p>Signed: </p><p>The Mediators’ Institute of Ireland Unit 2.1 The Distillers Building Smithfield Dublin 7 T: 353 1 609 9190 • E: [email protected] • W: www.themii.ie Payment options;</p><p>· Cheque payable to the MII sent to The Mediators’ Institute of Ireland, Unit 2.1, The Distillers Building, Smithfield, Dublin 7</p><p>· Bank Transfer</p><p>Payments in Euro</p><p>IBAN: IE97 AIBK 9310 4717 4580 69 BIC: AIBKIE2D</p><p>When making a transfer please be sure to use your name as a reference so that the payment can be identified when it arrives.</p><p>Payments in Sterling</p><p>IBAN: GB65 AIBK 2385 9012 4900 43 BIC: AIBKIE2D</p><p>· Paypal to [email protected] </p><p>The Mediators’ Institute of Ireland Unit 2.1 The Distillers Building Smithfield Dublin 7 T: 353 1 609 9190 • E: [email protected] • W: www.themii.ie </p>
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