Student Membership Form

Title:

Mr Mrs Miss Ms Other (please specify)

Given name:

Other names:

Surname:

Gender:

Male Female

Date of birth (dd/mm/yy)

Nationality:

Contact details

This will be your mailing & billing address. It will also dictate your annual subscription rate and branch allocation. Once admitted into enlistment, you may update where you have your correspondence sent to, through your online profile.

Address:

Town/city:

Postcode/zip:

County/state:

Phone:

Email Address:*

Facebook ID:

Twitter ID:

LinkedIn ID:

Part B: Academic Qualifications

Please provide details of relevant technical, academic and professional examinations passed including those of CiADR and Recognised Course Providers. We cannot process your application without this information.

Course title/Degree

Examination body/Institute/Organisation

CGPA/Result

Date completed

You are required to send proof of qualifications; including a copy of the syllabus and the results transcript, please provide additional sheets, if necessary for proof of qualification to member@ciadrbd.org

Which university are you currently studying in?

Please mention your student ID number

Are you involved in any kinds of extra curricular activities?

Yes No ( if Yes please mention the

name and role in those activities in short.)

Please mention at least two skills that you think you have ( For example- Leadership, Management,

Presntation, Writing, Research etc.)

Part C: Answer the following queries

What is your favourite virtue?

What are your favourite qualities in another person?

Waht is your cheif characteristic?

What is your main fault?

What is your idea of happiness?

What is your idea of misery?

If not yourself, who would you be?

Who is your favourite prose author?

Who is your favourite hero/heroine in fiction?

Who is your hero in real life?

What historical person do you most dislike?

What do you hate the most?

What is your natural talent?

What is your motto in ADR?

Who is your mentor?

Part D: ADR Academic Profile

We use this information to evaluate your level of ADR knowledge. It helps us to award you the most appropriate membership grade

Have you ever completed a CiADR approved course before? Yes (If yes, please specify details below) No

If yes, please specify the course(s):

Name of the Course Provider:

Are you interested to get training for ADR from YCiADR, CiADR and CIArb? Yes (If yes,please specify details below) No

Please Mention your previous exposure to ADR

What is your Motivation for application?

Field of Expertise

Please select areas of specialiation.

Language

Name of Language	Writing			Speaking			Reading
Name of Language	Excellent	Good	Fair	Excellent	Good	Fair	Excellent	Good	Fair

Checklist

Please check to ensure the following have been carried out before the form is sent to CiADR:

All sections of the form have been completed

You have completed the Data Protection Act questions

You have enclosed all copies of relevant certificates and documents

You have signed and dated the form

Part E: Declarations

I hereby apply for membership of the Centre for International Alternative Dispute Resolution. If admitted, I agree to comply with the code of professional and ethical conduct and by regulations made or to be made for carrying them into effect.

I declare that to the best of my knowledge, the information given on this form is correct. I understand and agree that if I make any false statements, submit false information or fail to disclose information requested in this application, I will be subject to disciplinary action to the constitutional documents and code of ethics, as amended from time to time.

On admittance, I request that you issue me a Membership Certificate. I agree that the certificate will remain the property of the Institute and will undertake to return it if I cease to be a member. I understand that I will be required to return my Certificate of membership on cessation of membership

Please refer to the CiADR Ethics section online for more information.

Upload Your Photo:

upload your passport size photo.

Signature:

Date:

Part F: Data Protection

Data entered into CiADR’s database is held subject to the provisions of the Data Protection Guidelines. By filling in and submitting this application form you agree to CiADR processing your sensitive personal data for the purposes as set out in the CiADR Data Privacy Notice.

Do you consent to CiADR sending you information about relevant CiADR activities by email?

Yes

Do you consent to CiADR sharing your contact information with carefully selected, relevant third-parties?

Yes