NOTE: MCFM offers INDIVIDUAL MEMBERSHIPS ONLY
If you are currently an MCFM member, please login before completing this application
Basic Annual Membership entitles you to a standard listing in MCFM’s online Members Directory. This listing includes your name, address, phone, fax and e-mail. You must purchase a Premium Annual Membership with Referral List and Profile if you wish to include additional information, such as your title, business name, web address and details about your practice and your qualifications. Only members who are actively practicing mediation may purchase a Premium Annual Membership.
Please complete the application below. Be sure to make a copy for your records before you press "Submit." After you submit your form, you will be taken to our payment page.
Questions? Email admin@MCFM.org
Check one:
Premium Annual Membership with Referral List and Profile $150 Basic Annual Membership $90
NOTE: You must complete the following certification section in order to join MCFM. If you are applying for a Basic Annual Membership, you must answer items 1-3, sign and date your application. If you are applying for a Premium Annual Membership with Referral List and Profile, you must answer items 1-4, sign and date your application. If you do not answer all required items, your application will be denied. Questions? Contact admin@MCFM.org.
I hereby certify that:
1) I am a member in good standing of my profession. Required.
2) I will uphold MCFM’s Standards of Practice. Review the MCFM StandardsRequired.
3) I agree to hold MCFM free, harmless and indemnified from all claims or causes of action arising from my practice as a mediator, including any errors or omissions in my listing in any MCFM directory.Required.
4) If I am applying for a Premium Annual Membership with Referral List and Profile, I have received a minimum of 30 hours of mediation training and I am actively practicing mediation.Required.
Signed (enter full name): Please sign.
Date (mm/dd/yyyy): Please enter the date.
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Please answer the following questions about your practice. MCFM aggregates information from all members for program development and outreach. Individual responses will remain confidential. Note: You must provide an answer to each question.
Mediation Training (check all that apply):Select at least one.
General Divorce/Family Both Other
Specialized (please list) List specialized when "Other" is checked.
Mediation is what % of your work:Select one.
25% or less 26% to 50% 51% to 75% 76% or more
Year you first began mediating: Not applicable Required.
Present hourly rates: High $ Low: $ Not applicable High rate required. Low rate required.
Family Mediation practice areas (check all that apply):Select at least one.
Pre-Divorce Gay/Lesbian Teacher/Training Post-Divorce Custody Consulting Unmarried Case Evaluation Other (please list) List when "Other" is checked.
Mediation practice business model (check all that apply):Select at least one.
Solo Practice Firm/Group Government Agency Nonprofit Other (please list) List when "Other" is checked.
Professional (non-mediation) background (check all that apply):Select at least one.
Psychology Law Business/Finance Social Work Human Services Education Religion Dispute Resolution Other (please list) List when "Other" is checked.
Check all degrees earned:Select at least one.
Doctorate J.D. Master's Bachelor’s Associate’s Other (please list) List when "Other" is checked.
Practice Areas:Select at least one.
Divorce Child Custody Cohabitation and non-marital planning Marriage Prenuptial and postnuptial agreements Estate planning Family business Elder care Probate of estates Same sex couples Other (please list) List when "Other" is checked.
Other (please list)
Copyright © 2012 Massachusetts Council on Family Mediation
