Mediation Council of Western Pennsylvania

  MCWP Membership Application

The Mediation Council of Western Pennsylvania is a non-profit organization that promotes mediation as an alternative to the traditional courtroom process.  We depend on membership dues to carry out the organization's mission of educating the public about mediation and supporting the professional development of mediators.

 The information contained in your application form will be added to the Membership List that is circulated to all members of the Mediation Council of Western Pennsylvania.

NAME:   _____________________________________________

_____________________________________________________

ADDRESS:____________________________________________

_____________________________________________________

_____________________________________________________

WORK PHONE:________________________________________

HOME PHONE:________________________________________

FAX:__________________________________________________

EMAIL:________________________________________________

WEBSITE:______________________________________________

MEMBERSHIP CATEGORY:

___ Individual  ($60)

___Organizational  ($200)

___Affiliate [volunteer mediator or mediation supporter]  ($25)

___Student   ($10)

TOTAL AMOUNT ENCLOSED:_________

Make check payable to: Mediation Council of Western Pennsylvania

Please mail application with dues payment to:

Beth Ansell

MCWP Administrator

5004 Sherwood Road

Bethel Park, PA  15102

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