Strictly Confidential - for Mediation Service Only 
Referrer name   Organisation (if applic) 

Address       Post Code 

Telephone No.   Email Address.

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Person/Family One   

Address       Post Code 

Telephone No.   Email Address.

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Person/Family Two   

Address       Post Code 

Telephone No.   Email Address.

Nature of the dispute and any other people involved:

If you are currently in dispute with another party or parties, please complete the on-line form below, giving as much detail as possible.

Clicking on the 'Send' button  will send this form via email to our Mediation Coordinator, who will be in touch with you as soon as possible

Rushmoor Community Mediation Service
The Community Centre, Meudon Avenue, Farnborough, Hampshire, GU14 7LE.
(Mail Only - Not a Manned Office) Telephone No. 07825 999 026

Mediation helps you find the solution

You have nothing
 to lose, all other options are still available

On-Line Mediation Referral Form

What users say about
 Rushmoor Mediation

"Thankyou for your help, normal relations have been restored.

Mrs.E.G. Aldershot

"I wish I 'd turned to the mediation service sooner. Thanks for all your help."

Mr. L M. Farnborough

" Your help was invaluable in resolving our dispute, thanks again"

Mr. G. W. Farnborough
Remember...
Mediation is:-
FREE

CONFIDENTIAL

and IT WORKS!

Could you be a

volunteer mediator?

Mediation is a
quicker process
than going through
the courts.