2007 annual dues are$25.00. All monies must be accompanied by a completed application form.

Please print.....please.....please

NAME ____________________________________

WORK PHONE __________________    CELL PHONE _________________ FAX _________________

EMAIL _____________________________________________________

MAILING ADDRESS:
Street address

City _________________________ State _____ ZIP ______________

Professional Mediation / Conflict Resolution Organizations to which you belong:

Criteria for Membership (quoted from the TMTR by-laws, Article 2.01)
The Texas Mediation Trainers Roundtable shall have members as defined under the Texas Uniform Unincorporated Non-Profit Association Act, to wit: a member is defined as a person who, under the rules or practices of the association, may participate in the selection of persons authorized to manage the affairs of the association or in the development of policy of the association, and who (1) is an experienced trainer, (2) has served as mediator for 20 sessions or 100 hours, (3) endorses the Texas Mediation Trainers Roundtable standards for trainings, (4) belongs to at least one other professional mediation organization, and (5) pays annual dues.

I affirm that I meet the TMTR criteria as set out above and intend to be an active council member.

_______________________________ ____________
Signature / Date

Please enclose a check in the amount of $25.00 payable to TMTR for your 2007 annual dues and mail it with the application to:

Kathy Bivings-Norris, Treasurer
PO Box 3609
Conroe, TX, 7730

If you do NOT want your name listed as a member on TMTR.org, please initial ___
If you do NOT want your contact information listed as on password-protected "members-Only" page of TMTR.org, please initial _____