FDR Centre Panels: Registration of Interest Please complete this form to register your interest in being a panellist with the FDR Centre. Please ensure you have read and understood the Rules relevant to the panel(s) you wish to be a member of before completing this form. If you find you need further information to complete the form, simply select "Save and Continue Later" at the bottom of the form. This will bring a popup window with a link. To be able to recover your draft, it is essential that you correctly type your email address in the popup window. You will receive an email with a link to your draft (please check your spam folder if you can't find the email in your inbox and never close the Internet browser before clicking “Save and Continue”). Please also note that the form contains conditional logic. As such, we highly recommend that you complete it sequentially. Contact DetailsIn this section you will be asked to provide us with your relevant contact details. Please note that email is our primary means of communication and for service of any documents. Should your contact details change at any time, please ensure you inform the Registry staff as soon as possible. In this section we also ask for information as to your age, gender, and nationality. Provision of this information is entirely optional. It is sought simply to better enable us to collate statistics on diversity of appointments.Name* Mr.Mrs.MissMs.Dr.Prof.Rev.SirHon. Prefix (Hon, Sir ...) First Last Suffix (QC, SC ...) Post nominals*Please include accreditations or qualifications (LLB, BA, BSc, PhD, C.IArb...) Phone*Please include the applicable country code.MobilePlease include the applicable country code.Can clients contact you via your mobile number? Yes No Your Email* Enter Email Confirm Email Service Address* Address Line 1 Address Line 2 City State / Province / Region Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal Address* Address Line 1 Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of birth (optional) DD slash MM slash YYYY Gender (optional) Female Male Non-binary Other/prefer not to say Nationality (optional) AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Nationality - if you hold more than one nationality please state below (optional)PanelsPlease select the Panels you wish to be considered for below.FDR Centre Panels*For information on our specific processes and rules please see the FDR Centre website. Family Law Arbitration Family Law Arb-Med Family Law Mediation FDR Mediation FDR Preparation for Mediation CIM - Child Inclusive Mediation Counselling General Mediation Elder Mediation AREAS OF PRACTICEIn the following sections you will be asked to provide us with further information regarding your areas of practice and background. By providing us with a short bio and profile photograph, you consent to that information being published on our website and used for general marketing purposes.ArbitrationFor professionals specifically trained and experienced in Arbitration law and practice.How many times have you been appointed as an Arbitrator?* How many Arbitration appointments have you had in the past 36 months in which an Award was published?* Please provide any further relevant information as to your Arbitration experience.Have you published an Award in an Arbitration or Adjudication with one or more of our Registries (FDR Centre, NZDRC, NZIAC, or BDT) within the past 24 months?* Yes No If you have not previously published an Award in an Arbitration or Adjudication with one or more of our Registries within the past 24 months, please upload a redacted copy of a recent Award.*If you have not previously published an Award , please instead provide us with a redacted copy of any similar document, for instance, a legal submission. Drop files here or Select files Accepted file types: doc, docx, pdf, jpg, png, Max. file size: 256 MB. Do you wish to be considered for arbitral appointments where Urgent Interim Relief is sought?* Yes No Please provide any relevant information as to your experience in dealing with applications for interim relief.*Are you willing to complete peer reviews for colleague panellists?*Our Registries operate a peer review process, requiring all written decisions to be subject to scrutiny prior to being issued to the parties. If you are interested in joining our list of peer reviewers, please indicate below and we will provide you with further information. Yes No Do you wish to be considered for the FDR Centre's fixed fee Arbitration services?*The FDR Centre provides a fixed fee service under its FLA45 Family Law Arbitration Rules. Please indicate below which, if any, or the levels of fixed fees services you would like to be considered for. ≤ $9,999.99 (Arbitrator's Fee is $3,000.00) $10,000.00 ≤ $19,999.99 (Arbitrator's Fee is $5,000.00) $20,000.00 ≤ $29,999.99 (Arbitrator's Fee is $7,250.00) $30,000.00 ≤ $39,999.99 (Arbitrator's Fee is $8,500.00) $40,000.00 ≤ $49,999.99 (Arbitrator's Fee is $10,000.00) I do not wish to be considered for the FDR Centre's fixed fee services MediationFor professionals specifically trained and experienced in the practice of Mediation.How many times have you been appointed as a Mediator?* How many Mediations have you conducted in the past 36 months?* Please provide any further relevant information as to your Mediation experience.Arb/MedFor professionals specifically trained and experienced in Arbitration and Mediation law and practice.How many times have you been appointed to act in the dual Arbitrator/Mediator role?* In how many of those cases was the Arbitration reconvened?* FDR MediationFor professionals specifically trained and experienced in the practice of FDR Mediation and who hold the appropriate accreditation to practice in this area.How many times have you been appointed as an FDR Mediator?* How many FDR Mediations have you conducted in the past 36 months?* Please confirm your ADRO Accreditation for FDR Mediation below*All FDR Mediators must hold appropriate accreditation to be considered for appointment. NZLS Resolution Institute AMINZ I provide professional supervision* Yes No Please provide any further relevant information as to your FDR Mediation experience.FDR Preparation for MediationFor professionals working in FDR Mediation who are also trained and experienced in providing Preparation for Mediation for that process.How many times have you been appointed as a Preparatory Counsellor for FDR Mediations?* How many Preparation for Mediation sessions have you conducted in the past 36 months?* Please provide any further relevant information as to your FDR Preparatory Counselling experience.Child Inclusive Mediation (Voice of the Child)For professionals specifically trained and experienced in child inclusive practice.How many times have you been appointed as a Child Inclusive Specialist?* How many Child Inclusive Mediation processes have you conducted in the past 36 months?* Please provide any further relevant information as to your experience in providing Child Inclusive Mediation services.CounsellingFor professionals specifically trained and experienced as Counsellors.How many times have you been appointed as a Counsellor?* How many Counselling sessions have you provided in the past 36 months?* Please provide any further relevant information as to your Counselling experience.Geographic Areas of PracticeI am interested in working in the following geographic locations:* Auckland (Central) Auckland (East) Auckland (North) Auckland (South) Auckland (West) Bay of Plenty Canterbury Chatham Islands Coromandel Franklin Gisbourne Hauraki Gulf Hawkes Bay Manawatu-Whanganui Marlborough Nelson Northland Otago Rodney Southland Stewart Island Taranaki Tasman Waikato Wellington West Coast Areas of ExpertisePlease select below your relevant areas of experience and expertise.Family and Relationship Areas of Expertise Adolescent/Teenage Issues Adult Family and Elder Care Anxiety Depression Domestic Violence Drug and Alcohol Abuse Extended Family Issues Gambling Addiction Gender Issues Grief Illness and Disabilities Loss and Anger Multi-Cultural Relationships Multi-Generational Issues Parenting/Care and Contact Issues Pre and Post Nuptial Agreements Relationship Property Relocation Re-Partnered/Blended Family Issues Separation Sexuality Issues Wills and Estates Other (please specify below) Other areas of expertise (Family and Relationship)I have specific expertise in working with the following cultural, religious, ethnic, or gender groups: Bisexual Catholic Chinese Eastern European Fijian Fijian Indian French Gay Hindu Hispanic Indian Japanese Jewish Lesbian Malaysian Middle Eastern Muslim Māori Pasifika Pentecostal Protestant Russian Samoan South African Tahitian Thai Tongan Transgender Vietnamese Other (please specify below) Other areas of expertise (cultural, religious, ethnic, or gender groups)Languages* English Māori Arabic Bengali Burmese Cantonese Farsi Fijian Filipino French German Hebrew Hindi Japanese Khmer Korean Lao Malay Mandarin Nepali Portuguese Punjabi Russian Samoan Sinhala Spanish Tahitian Tamil Thai Tongan Turkish Tuvaluan Urdu Uzbek Vietnamese Other (please specify below) Other languagesProfileIf you are successful with your application, your Profile and Profile Photo will be published on the relevant Registry website. Please note that we reserve the right to decline to publish any aspect of your Profile as submitted in this form.CV/Resume*Please upload a copy of your current CV/Resume.Max. file size: 256 MB.Profile for FDR Centre Website*Please set out your profile in paragraph format (rather than bullet points). Your profile should be limited to 5,000 characters. If you are successful with your application, your profile will appear on the FDR Centre website. Profile photo*jpg or jpeg 200 x 200 px (or similar to passport photo dimensions)Accepted file types: jpg, jpeg, png, Max. file size: 256 MB.Professional OversightThe FDR Centre is not a membership body and does not provide professional disciplinary oversight. As such, and to ensure our clients receive the highest quality service, it is a prerequisite to being on our panels that you are a member of a relevant professional body.I confirm that I am currently a member of a relevant professional body.* I confirm the above Professional Memberships* Chartered Institute of Arbitrators Resolution Institute AMINZ NZ Law Society NZ Bar Association Other Other Professional Memberships*Are you currently, or have you previously been, the subject of any professional disciplinary action or complaint arising from the provision of the services you offer?* Yes No Please advise whether the complaint was upheld and, if so, what if any sanctions were applied by the professional body.*RefereesPlease provide details below for two referees. By providing this information you consent to us contacting these referees for the purposes of processing your application.FIRST REFEREE*Please set out below a brief description of your referee's role and relationship to you.Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Email* Enter Email Confirm Email Phone*SECOND REFEREE*Please set out below a brief description of your referee's role and relationship to you.Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Email* Enter Email Confirm Email Phone*Payment/Bank detailsIn this section you are asked for your payment/bank details. This is the bank account into which any payments for your services will be made. Should these details change, please ensure to update the Registry staff without delay. If you are New Zealand tax resident, please provide us with your GST number. If you do not have a New Zealand bank account, payment can be made into a foreign bank account. Any transfer costs will be borne by the recipient.Do you trade through a company?* Yes No Company Name* Company Number* Are you tax resident in New Zealand?* Yes No GST Number:*Do you have a New Zealand bank account?* Yes No Bank Name* Account Name* Account Number* Swift Number* Hourly Rate*In NZD inclusive of GST or other related tax. Room availabilityDo you have rooms available for the provision of your services?* Yes No Available rooms: please advise what room availability you have and whether there would be any charge to hire those rooms.*Confirmation and SubmissionI confirm that I have read and understood the relevant FDR Centre Terms and Conditions relating to the panels for which I am registering my interest, and that I agree to abide by those Terms and Conditions in carrying out any services provided by the FDR Centre as applicable.* I confirm the above I consent to the FDR Centre using any of my personal information provided in this application form for the purposes of the FDR Centre providing its services. Such use may include processing my application, creating a bio on the FDR Centre website, making appointments, and general marketing.* I confirm the above I understand that admission to any of the FDR Centre's panels is at the sole discretion of the FDR Centre, that any such decision is final, and that the FDR Centre is not required to provide any reasons for its decision.* I confirm the above
