Membership Application

Tennessee Association of Professional Mediators

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PO Box 150626

Nashville, TN 37215-0626

Phone: 615-383-8276

Membership Application

Please fill out the application, click submit and mail your dues check payable to TAPM to: TAPM P.O. Box 150626 Nashville, TN 37215-0626

MEMBERSHIP DUES: (Annual Dues are collected each March)

Member: $100.00 (Members must be Rule 31 trained) - This entitles you to be a voting member, receive e-news, an individual web page on the TAPM website, plus discounted CME.

Non-Voting Member: $50.00 This category includes students, volunteer mediators and interested members of the public or judiciary. This entitled you to attend all meetings, receive e-news andhave discounted CME.

After your dues check has been received, TAPM will set up your personal web page on the TAPM website. You will be notified by email of your user name and pasword. Then you may access your web page and make any updates you choose,including uploading a picture of yourself.

If you have any questions, please call or use the Contact Information Form on the web site.

Lisa Smith TAPM Executive Director 615-383-TAPM.

Name

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Title

Company

Address

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,	city, state/prov zip

Phone

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Please list all mediation training you have received:

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List mediation certifications you have received:

(R)