Promoting the choice to mediate

Step 3: If you purchased a membership, please provide us with the information for our membership directory. (Required fields in bold red)

(If you only signed up for the conference, without purchasing a membership, you can skip this step.)

Full Name:

Email address:

Mailing address for directory listing:

Organization:
(required for organization membership)

Designated Representative:
(required for organization membership)

Work Phone:

Home Phone:

Website Address:

Please do NOT include my information in the publically accessible Locate A Mediator section of the website. I understand all members are listed in the members-only directory.

Employed as Mediator by:

Volunteer as Mediator with:
(required for volunteer membership)

Primary County You Work in:

Secondary County You Work in:

Third County You Work in:

The Primary Region(s) of Pennsylvania You Work in: (see Regions Map for definitions)
(check all that apply)

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

Areas Of Mediation Practice: (check all that apply)

Agriculture
AIDS
Behavioral
Business
Charitable Foundations
Child Custody
civil rights
Community
Co-parenting
Conflict Coaching
Construction
Consumer
Deaf &Hard of Hearing
Disability
Divorce
Domestic Violence
Elder Issues
Employment
Environment
Estates & Trusts
Executive Coaching
Families
Family Business
Farm Credit
Financial Institutions
Gang
Groups Orgs
Health Care
Heirs & Beneficiaries
Insurance
Intellectual Property
Intercultural
International
Labor/Mgmt
Landlord/Tenant
Medical Malpractice
Mental Health
Non-Profit Organizations
Orphans Court
Personal Injury
Probate & Trusts
Public Policy
Public Utilities
Real Estate
Religious
Right of Way
Schools
Securities
Small Claims
Special Education
Training
Victim-Offender/Corrections
Workers Compensation
Youth

Please provide a brief statement (two sentences, apx. 25 words) describing your background and involvement in mediation:

Your interest in getting involved with PCM:

How did you hear about PCM?

Internet Search
Friend/colleague
Link from Mediate.com
Conference Mailing
PCM Newsletter
Word of Mouth
Mediation Training
Other (please specify)
       
Step 4: Please affirm

I affirm that the PCM Standards for Ethics will guide my practice of Mediation.

   
   

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.