s Pennsylvania Council of Mediators - Membership Application

Promoting the choice to mediate

Join the Pennsylvania Counsel of Mediators

Part 1 (of 2) - Select Membership Category

Membership Category and Fees

Individial / Professional $70

Includes a listing in the Locate A Mediator section, unless you declined this feature on the membership information form.

Organizational/Group $70

Includes a listing in the Locate A Mediator section, unless you declined this feature on the membership information form. Entitles the organization to one conference registration at the member's rate.

Volunteer $35

I do not receive financial compensation for services. Includes a listing in the Locate A Mediator section, unless you declined this feature on the membership information form.

Student $25

*Note* - Student membership requires evidence of current enrollment.
Email copy of Student ID to info@pamediation.org.

Part 2 (of 2) - Please provide the following information (required fields in red)

First Name/Organization Name:

Last Name/Organizational Contact:

Email Address:

Address:

Address (2):

City:

State:

ZIP:

Organization:

Designated Represenative:

Work Phone:

Home Phone:

Website Address:

Employed as Mediator by:

Volunteer as Mediator with:

Primary County You Work in:

The Primary Region(s) of Pennsylvania You Work in:

PA Statewide
Northwest
North Central
Northeast

Outside PA
Southwest
South Central PA
Southeast PA

Areas Of Mediation Practice: (check all that apply, at least one)
Agriculture
AIDS Heirs
Behavioral Insurance
Business Intellectual Property
Charitable Foundations Intercultural
Child Custody Divorce
Civil Rights International
Community Labor/Management
Conflict Coaching Landlord/Tenant
Construction Medical Malpractice
Consumer Mental Health
Co-parenting Non-Profit Organizations
Deaf Community Orphans
Disability Personal Injury
Domestic Violence Probate
Elder Issues Public Policy
Employment Public Utilities
Environment Real Estate
Estates Religious
Executive Coaching Right of Way
Family Business Schools
Families Securities
Farm Credit Small Claims
Gang Special Education
Groups/Organizations Training
Health Care Victim-Offender
OTHER (specify) Workers' Compensation

Our directory includes space for a brief description of your mediation involvement: (25 words max)

Your interest in getting involved with PCM:

PCM publishes a newsletter three times a year.
Please indicate which format you prefer to receive:

Pennsylvania Council of Mediators | P.O. Box 23, Oakmont PA 15139 | info@pamediation.org

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PCM's web site is designed to provide accurate and authoritative information relating to the field of mediation and mediation services in Pennsylvania. This information is provided as a public service, with the express understanding that, in providing it, neither PCM nor any of its officers, directors or employees is engaged in rendering legal or financial advice. If legal or financial advice or other expert assistance is required, the services of a qualified attorney or financial expert, respectively, should be sought.