CPFA 2010 Application (K0217677.DOC;1) by 8hjrtwg

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									                      THE CENTER FOR PRINCIPLED FAMILY ADVOCACY
                                                    W W W. F A M A D . C OM


                                        2010 MEMBERSHIP APPLICATION

 1.     NAME:
                                            LAST NAME                  FIRST NAME         MIDDLE INITIAL


 2.     OFFICE ADDRESS:
                                            STREET ADDRESS                                SUITE NUMBER

                                            CITY                           STATE            ZIP CODE


 3.     TELEPHONE NUMBER:                                                  4. FAX NUMBER:
                                            AREA CODE                                          AREA CODE
 5.     E-MAIL ADDRESS:

 6.     PROFESSION:
                                             SUPREME COURT REGISTRATION NUMBER (ATTORNEYS)

         Circle Membership Class             Class A:          Attorneys

                                             Class B:           Family Law Related Professionals
                                                               (Psychologists, Mediators, Business Valuators, etc.)

                                             Class C:          Court Personnel (excused from membership fee)

I understand that by signing and submitting this application, I am affirming to the Executive Committee of the Center the following:
        1.        That I have professional liability insurance in force and effect as of this date;
        2.        That I understand that the CPFA is dedicated to returning to individual clients and families control over the
                  decision as to the process(es) to be utilized in family dispute resolution;
        3.        That as a member of the CPFA, I commit to identifying to my clients all of the reasonable and appropriate family
                  dispute resolution processes presently available; including, but not limited to, principled negotiation, collaboration,
                  mediation, arbitration and litigation;
        4.       That as a member of the CPFA, I commit that if another member of the CPFA is engaged in the representation of an
                 opposing party or interest in the family dispute or matter, I will meet with that member, and our clients where
                 appropriate, within a reasonable time to identify and establish the process(es) by which the family dispute or matter
                 will be resolved;
        5.       That I commit to the following: (a) attend a minimum of four meetings annually; (b) completion of the Basic
                 Collaborative Training within twelve months of membership; (c) participation in a minimum of one CPFA approved
                 CLE per year. Failure to meet the foregoing criteria will result in loss of membership. Deviation from said
                 requirements shall be handled in a case-by-case basis by the Executive Committee.


SIGNATURE OF APPLICANT                                        DATE                                 AMOUNT OF MEMBERSHIP FEE
                                                                                                          ENCLOSED
ANNUAL MEMBERSHIP FEE: $250.00 - Class A Membership Fee (Class A members through December 31, 2010)
                                   $150.00 - Class B Membership Fee (Class B members through December 31, 2010)
                                   $100.00 - One-time processing fee (new Class A members only).

      PLEASE MAKE YOUR CHECK PAYABLE TO "THE CENTER FOR PRINCIPLED FAMILY ADVOCACY"
                                Please Remit Payment to:
                                          Center for Principled Family Advocacy
                                              c/o Sarah Gabinet, Treasurer
                                           1375 East Ninth Street, 20 t h Floor
                                                   Cleveland, Ohio 44114
{K0217677.1}

								
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