LSSA

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Full Name (Accredited Mediator): *

ID Number: *

LSSA or LPC registration No *

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Date of Birth:

Email Address: *

Mobile Number: *

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Region: Gauteng Limpopo Eastern Cape Western Cape Free State Mpumalanga Kwa-Zulu Natal Northern Cape North West

RAF and Personal Injury

Do you want to mediate these matters? ( If YES then you MUST attached the below document )

Letter of Experience

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Please provide evidence of this specific training and/or letter of experience

Member Fee Structure ( Your mediation fees )

Fee Per Hour: *

Deposit Amount: ( If Applicable )

Terms & Conditions

Please note the fee of R2,500.00 Incl VAT is payable by the member on creation of this profile. You will be emailed the invoice once paid. On the anniversary date you will be invoiced the applicable annual membership fee at that date. This fee includes a public facing profile, where attorneys can search for you, AND your own digital CPD Logbook.

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Annual Member Fee

Invoicing DetailsIf you would prefer receiving an invoice before payment please provide your details. Alternatively please attached your Proof of Payment below.

PROOF OF PAYMENT ( See above LSSA Membership fee )

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Allowed: pdf, doc, docx, txt, xls, xlsx

Bank Name : FNB Account Type: COMMERCIAL CASH MAN ACCOUNT Account Number: 62009641079 Branch Code: 251445 Branch Name: PRETORIA

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Members Directory

Personal Information

Professional Information

RAF and Personal Injury

Member Fee Structure ( Your mediation fees )

Terms & Conditions

Annual Member Fee