MTMA

Montana Mediation Association
Application for Associate Membership

Session ID: 44442287797719945407434234

APPLICATION INSTRUCTIONS: Please answer the following questions.  Incomplete applications will be returned for further information.  The Qualifications committee reviews all applications within 12 weeks.  If you have questions, or qualification obstacles, call the MtMA office at (406) 241-2422.

MEMBERSHIP DUES and APPLICATION FEES.  Membership dues must be enclosed with your membership application.  If membership is denied, your dues will be returned.

PRIVACY NOTE.  The contents of this application will not be sold or distributed.  Successful applicants will have their name published in the MtMA Directory.


PART I.  Enter your contact information as you wish it to be listed in the membership directory.  All membership materials will be sent to this address.

Title

First Name

MI

Last Name

Address Line 1

Address Line 2

City

State

ZIP Code

Daytime Phone Number

Fax

Email Address

Occupation and employer information will not be printed in the membership directory.

Occupation

Employer


PART II.  Please specify which category of membership you are applying for.

  ASSOCIATE MEMBERSHIP ($50 per year) is for any individual or organization interested in furthering the purposes of MtMA, who has been approved for membership and is current in the payment of annual dues.


PART III.  Please list any areas of dispute resolution other than mediation that interest you.


PART IV.  As a member of MtMA, I will subscribe to the purposes and principles of the Association.  I will further certify the information supplied on this application is true, correct, and complete to the best of my knowledge.

Signature (Write your name.)

Date


How did you hear about MtMA?

(Name: )

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