Mediation Council of Western Pennsylvania
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:
Christine Kornosky, JD
Treasurer, MCWP
312 Second Avenue
Carnegie, PA 15106
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