If you would like to register your interest in becoming a TalkingWorks trainer or coach, please send us some information via the form below and we'll contact you as soon as possible. Personal Details Title * First name * Surname * Email * Address 1 * Address 2 Town/City * County Postcode * Enter at least one daytime contact number: Phone Mobile Mediation Accreditation Mediation accreditation * CEDR ADR Group CIARB Regent's University London School of Mediation Other... Mediation accreditation Other... Date accredited * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Accreditation certificate * Upload your certificate of accreditation in .jpg, .tif, .png or .pdf format. File size is limited to 2 MB. TalkingWorks Experience Previous involvement * Have you previously acted as a coach at a TalkingWorks training? Yes No Training attended If yes, please provide the name of one school and the date of the training. Other relevant experience Declaration I declare that: I have never been cautioned for or convicted of any offence relating to children or young people. I have never been subject to any disciplinary action or sanction relating to children or young people i.e. that my name does not appear on the sex offenders register, DBS barred list and that I am otherwise not known to the police, any local authority social services department or any employer as being an actual or potential risk to children or young people. I consent to my personal data being processed and kept by TalkingWorks in accordance with the Data Protection Act 1998 in connection with the purposes of the charity and for the protection of children and young people. I acknowledge and accept that TalkingWorks reserves the right to verify the information that I have provided and to conduct such checks (including without limitation DBS checks) that it sees fit to verify such information. I hereby give my consent to such checks.