To speak with
someone about mediation or PCM membership, call (610) 526-1802 (Phoebe Sheftel)

© Pennsylvania Council of Mediators

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Payment by Check
Please fill out this form on-screen and print a copy.
USE GRAYSCALE SETTING TO SHOW CHECKED BOXES WHEN PRINTING.

Mail completed form, with your check made out to "PCM", to:

PCM
c/o Phoebe Sheftel
414 Barclay Rd.
Rosemont, PA 19010

Step 1: Select Membership Category
Membership Category and Fees
Individual/Professional     $60
Receive financial compensation for mediation services.

Organizational/Group     $60
Entitles organization to one member rate conference registration.

Volunteer     $35
I do not receive financial compensation for services.

Student     $35
Include copy of proof of status with form to qualify.

OMIT Listing on PCM's site     FREE
All members are listed in the public Locate A Mediator searchable section of the PCM web site. Please check here if you want your name OMMITTED from this listing and only want it included in the members-only accessible directory
Step 2: Please provide the following information (required fields in red.)

First Name:

Last Name:

Email:

Address1:

Address2:

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: (see Regions Map for definitions)

PA Statewide     Northwest     North Central     Northeast
Outside PA Southwest South Central PA Southeast PA

Areas Of Mediation Practice: (check all that apply)

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

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

Your interest in getting involved with PCM: