Current Membership Status: *

           I am currently a member of the North Carolina Association of Professional Family Mediators

           Please accept my application as a new member

Name:  

  Mr. Mrs. Miss Ms. Dr.    First: *     Middle: *     Last: *     Suffix:    N/A Sr. Jr. I II III   

Name by which you wish to be addressed: *      

Number of years in dispute resolution field: *                              

Contact Information:   

Company Name: 

Mailing Address:*   

City:*        State: *          Zip Code: *    

Telephone: (at least one contact number is required)

Office:       Cell:        Fax:       Home:   

Email address where you wish to receive correspondence from the NCAPFM: *

Website address:

Would you like to use your talents on a committee?

Continuing Education - Plans and coordinates educational programs on topics of interest to members.

Hospitality - Provides refreshments and other supplies for programs or meetings.

Communications - Disseminates information about the association, its activities, and ADR to members.

Membership - Responsible for annual membership renewal and list maintenance.

What is your membership category? *

General - for any individuals who are interested in or involved in family mediation

Practitioner - for those who meet one of the following criteria (please indicate criteria met):

            Completed 40 hours of family mediation training approved by the ACR or the NCDRC and have been practicing for 3 years

            Custody and visitation mediator employed by the Administrative Office of the Court

            Family Financial Mediator certified through the NC Dispute Resolution Commission

New this year is the ability to accept credit and debit cards for dues payment. 

In order to reduce the workload of our volunteer officer members, we prefer

this as our primary method of transaction processing.  

However, we will continue to accept checks. *

    I intend to pay by credit/debit card  (Preferred Method)

    I intend to mail in a check

Online Directory Listing service: *  (Members must be practitioner category to be eligible to list)

  Make selection I would like to add a new listing I am not interested in having my name in the online listing I am currently listed and I do NOT wish to renew I am currently listed and I wish to renew that listing