2007 annual dues are $10.00. 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
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 (1) has an interest in training (2) endorses the Texas Mediation Trainers Roundtable standards for trainings, and (3) pays annual dues.

I affirm that I meet the TMTR criteria as set out above.

_____________________________ _____________
Signature Date

Please Check
Please enclose a check in the amount of $10.00 payable to TMTR for your 2007 annual dues and mail it with the application to:

Kathy Bivings-Norris, Treasurer
PO Box 3609
Conroe, TX, 77305

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 _____