CLIENT REGISTRATION, MEDIATION AGREEMENT & INTAKE DISCLOSURE FORM

HUMAN RIGHTS ADVOCATES AUSTRALIA (HRAA / HRA AUSTRALIA)

CLIENT REGISTRATION, MEDIATION AGREEMENT & INTAKE DISCLOSURE FORM
Party A Details*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number*
Phone Number
Please enter a valid phone number.
E-mail*
example@example.com
Other Party Details*

First NameLast Name
Address (if known)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number (if known)
Phone Number (if known)
Please enter a valid phone number.
E-mail (if known)
example@example.com
How did you hear about us?*
Nature of Dispute*
IMPORTANT NOTICE
You are the engaging party initiating contact with HRAA.

By completing this form:
- You are requesting that HRAA assess suitability for mediation.
- You understand that mediation cannot proceed unless the other party voluntarily agrees.
- You acknowledge that once mediation proceeds, the mediator does not act for you or the other party.
PART 2 – NATURE OF SERVICE REQUESTED - If mediation is selected, this document forms the Mediation Agreement upon signing*

Mediation Services
Services*
prevnext( X )
Pay in advance Mediation Service 5% discountYou are paying for a professionally facilitated mediation process conducted in accordance with recognised national standards. This includes intake and suitability assessment, conflict checks, preparation, session facilitation, administrative coordination, and outcome documentation where applicable. All prices are in Australian Dollars (AUD) and inclusive of Goods and Services Tax (GST) where applicable.
$3,135.00AUD

Payment Schedule Mediation ServiceYou are paying for a professionally facilitated mediation process in accordance with recognised national standards. This includes intake, suitability assessment, conflict checks, preparation, session facilitation, administrative coordination, and outcome documentation where applicable. A $500 advance payment is required, with a minimum of $250 per fortnight thereafter. No pre-mediation work will commence until all service fees are paid in full. All prices are in Australian Dollars (AUD) and inclusive of Goods and Services Tax (GST) where applicable.
$3,300.00AUD Quantity

Total

$0.00AUD
Human Rights Advocates Australia only use bank transfer for payment method. This helps to protect your credit card information online.

Name: HRAA

BSB: 814282

ACC: 51499119

**PLEASE CHECK OVER THESE DETAILS MUTIPLE TIMES BEFORE SENDING PAYMENT TO AVOID AN INCORRECT MONEY TRANSFER.
By my signature below, I acknowledge that I have read, understood, accept, and agree to all terms set out in this Client Registration, Mediation Agreement, and Intake Disclosure Form, including the nature of the mediation process, fees and payment obligations, refund policy, confidentiality, and the voluntary and neutral role of the mediator. I also acknowledge that I have read and agree to be bound by the Terms and Conditions available at https://humanrightsadvocates.com.au/terms-and-conditions.*

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HUMAN RIGHTS ADVOCATES AUSTRALIA (HRAA / HRA AUSTRALIA)