Referrals to Community Mediation

Referral Made By *

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Last

Your Position

If Other, Describe

Involved Applicable want

Your Email *

Party 1 *

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Contact Information for Party 1

Please include any or all of the following: mailing address, phone number(s), email address

Party 2 *

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Last

Contact Information for Party 2

Please include any or all of the following: mailing address, phone number(s), email address

Additional Parties Involved and Contact Information, If Applicable

Next Court Date, If Applicable

Nature of Situation/Dispute

Case/File Number(s)

County *

Anything else you want to share?

Security Question: *

The mission of the Mediation Center is to create opportunity from conflict.

We are a 501(c)3 nonprofit organization serving Buncombe, Henderson, Transylvania, and Polk Counties in Western North Carolina

Your gift creates a safer and more peaceful community for everyone. Thank you!