Membership Application

Please enroll me as a member of The New York State Council on Divorce Mediation for the current membership year.
(Complete the statement below in agreement)

I, , hereby affirm that I have met the standards for membership as set forth in this application and will adhere to the Model Standards of Practice and NYSCDM By-Laws as posted on the NYSCDM website. If this is a renewal application, I also certify that I have met the continuing education requirements as provided in this application.

 

Membership Enrollment Type





 

Directory Listing Options





Total Due:
 

 

  • Membership is $150 for all classifications of individual membership.
  • CDRC membership is $200
  • First time individual members receive a discount. Membership is $100 for the first year.
  • Membership entitles you to a listing on the Council's web page directory.
  • Additional directory listings and active links can be included for an additional fee.
    Option A is free. To be included, please check the appropriate box.

 

Membership Status







Training


Please indicate appropriate proof of mediator status

 

  • Accredited Member is a member who has been granted Accreditation through demonstrated education and experience
  • Mediator Member is any member who has completed comprehensive family and divorce mediation training including a domestic violence component, or is a family law attorney or Certified Divorce Financial Analyst who has completed basic mediation training and a domestic violence component
  • Affiliate Member is any individual interested in the field of mediation or supporting mediation.

Education Requirements
Accredited and Mediator members are required to have at least ten hours of continuing education per year.

 

Main Contact Information

Full Name:
  
Street Address 1:
  
Street Address 2:
  
City/State/Zip:
      
County:
  
Phone Number
  
Fax Number:
  
Email Address:
  
Would you prefer to receive correspondence by:
?
 

 

Home Number (Optional):
  

 

Directory Listing

Degrees listed after your name (e.g. Esq., J.D., M.S.W.):
  

Primary Directory Listing

Practice/Company Name:
  

   Use contact information as above
Street Address 1:
  
Street Address 2:
  
City/State/Zip:
      
County:
  
Phone Number:
  
Fax Number:
  
Email Address:
  

 

Additional Directory Listing

Practice/Company Name:
  
Street Address 1:
  
Street Address 2:
  
City/State/Zip:
      
County:
  
Phone Number:
  
Fax Number:
  

 

Payment Method