Please fill out the information below to become an Acesin Affiliate.
Account information
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A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Information
Mr, Mrs, Dr, etc...
Please enter your first name
Please enter your middle name.
Please enter your last name
Can include Jr., Sr.,Dr., III, etc.
A nickname you prefer.
Name of Organization
Your business address
Enter your contact telephone number (1234567890).
Enter your cell phone number, (1234567890).
A valid url to your firm's website. Example: http://yourdomain.com
If you are not a licensed attorney, you must complete the three References fields below.
Other State Bar Admissions
Describe e-Discovery training (limit 250 words) (If you have no e-discovery training and would like to attend an ACESIN training, please check the box below)
Yes, I would like to attend an ACESIN training to fulfill my application requirements. The content of this field is kept private and will not be shown publicly.
Years in ADR
Undergraduate Degree and Institution
Post-Graduate Degree and Institution
Post-Graduate Degree and Institution
Post-Graduate Degree and Institution 3
Other specialized degrees and/or certifications
How many e-Mediations have you conducted as the e-neutral? The content of this field is kept private and will not be shown publicly.
How many special master appointments (or other court appointments) in e-discovery have you had? The content of this field is kept private and will not be shown publicly.
Describe your E-mediation experience
References
Reference 1 Name (Required if you are not an attorney).
Reference 1 Address (Required if you are not an attorney).
Example: 123 street name, Suite 101, Birmingham, AL 12345
Reference 1 Phone (Required if you are not an attorney).
Reference 1 Email (Required if you are not an attorney).
Reference 2 Name (Required if you are not an attorney).
Reference 2 Address (Required if you are not an attorney).
Example: 123 street name, Suite 101, Birmingham, AL 12345
Reference 2 Phone (Required if you are not an attorney).
Reference 2 Email (Required if you are not an attorney).
Reference 3 Name (Required if you are not an attorney).
Reference 3 Address (Required if you are not an attorney).
Example: 123 street name, Suite 101, Birmingham, AL 12345
Reference 3 Phone (Required if you are not an attorney).
Reference 3 Email (Required if you are not an attorney).
Terms
You must select one of the following. The content of this field is kept private and will not be shown publicly.
I acknowledge that my application will not be reviewed until ACESIN has received my $150.00 non-refundable application fee. If accepted as an ACESIN Fellow, I agree to pay ACESIN the annual membership fee based on the date of my application as follows:

January 1 to June 30: $700
July 1 to December 31: $550

The non-refundable application fee of $150.00 will be applied as a credit to the payment of the Fellow's annual memberhship fee in the first year of membership. Annual membership fees renew in January of the following year. (For example, if you apply in April of 2011, you will pay $150.00 non-refundable application fee. If you are accepted, you will pay a $700.00 minus the $150.00 application fee for a total of $550.00. In January of 2012, you will pay the 2012 membership fee.)
The content of this field is kept private and will not be shown publicly.
Terms of Service
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