Step 1 – New Member Application Name:* First Last Call me by the name of:Address:* Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Phone:* Area Code - Phone Number Fax: Area Code - Phone Number Mobile Phone: Area Code - Phone Number E-mail:*Website Address:Years in the ADR field:Are you an attorney?*NoYesAs an ATTORNEY, what fields do you serve?DivorceEmployer/EmployeeChild Custody OnlyElder CareOther Family IssuesWills/EstatesWorker's CompensationHealthcare/MedicalPersonal InjuryContractsReal EstateAs a MEDIATOR, what fields do you serve?DivorceEmployer/EmployeeChild Custody OnlyElder CareOther Family IssuesWills/EstatesWorker's CompensationHealthcare/MedicalPersonal InjuryContractsReal EstateNo training or experience is necessary to be a member. However, please let us know which of the following apply to you: (Check all that apply) I have completed a 40 hour family mediation training course approved by the ACR/NCDRC.I have been a practicing mediator for at least 3 years.I am a Custody/Visitation mediator for the AOCI am an FFS mediator certified by the NCDRCSubmitReset