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Membership Renewal
First Name
Last Name
Has any of your contact information (name, email address, phone number, address, website) changed since your last application?
*
Yes
No
Has any information changed about your areas of mediation practice since your last application?
*
Yes
No
If you appear on the Directory of Mediators on the website, do you continue to maintain insurance for your mediation practice?
*
Yes
No
If you appear on the Directory of Mediators on the website, do you continue to take at least 5 hours per year of mediation/ADR continuing education?
*
Yes
No
Please select your membership category
*
Individual on or before 2/28/21: $85
Individual after 3/1/21: $100
Corporate/organizational: $200 (Allows up to four (4) participants at each Council educational function and one (1) membership vote)
Affiliate (volunteer mediator or mediation supporter): $25
Student: $10
Newly-trained mediator on second year of membership: $50
How would you like to pay your dues?
*
Paypal (STRONGLY preferred)
By check made payable to MCWP
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