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Self-rep Provider Directory Listing Form 2017-06-27T17:40:39+00:00

Self-rep Provider Directory Listing Form

For the Main Directory Page

The name you want on the Directory main page. This might be your business name or your personal name (required)

Your practice category (required)

If you’re a lawyer, please confirm you’ve devoted at least 75% of your time during the past 3 years to your listed practice category

If you’re a mediator, please confirm you’ve devoted at least 50% of your time during the past 3 years to your listed practice category

If you’re a therapist, please confirm you’ve devoted at least 50% of your time during the past 3 years to your listed practice category

A one (short) sentence of what you do

For Your Personalized (John Doe) Page

See a current mock-up of the personalized page HERE

A blurb of around 150 words to go under the heading: Who am I?
This is to give the user an idea of who you are, your general practice, and your interest in helping self-reps

The title of your 3 Pillar service and a brief description including the predefined service and the cost.
If you will be offering more than one 3 Pillar service, list the title, information, and cost for each one

A title and description of your normal service or services

Your Contact Information

Phone (required):

Email (required):

Website:

Other, Facebook, Twitter, LinkedIn etc.:

Attach a photo or logo for your Directory Listing. (450px wide minimum)

The only cost to be listed in the Directory is $85 + HST, to cover the charge by the web designer to create a dedicated page with your information. Once your information is approved, an invoice will be sent to the address provided.