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Mediation Form:
Please complete as much of the form below as you possibly can. Bear in mind that the more information you supply, the better CHEC will be able to assist you. Thank you.

Your Name:

Email Address:

CHECtravel Number:

Your Home Exchange Club:




Exchanger Home Exchange Club:

When did the incident in question occur (MM/YY)?

Have you notified the offending party?


Have you attempted to resolve the problem with this individual?


Nature of the Problem:

 




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