Application For Membership

Name
Organisation*
Address*
Post Code*
Telephone*
Fax*
Mobile
E-mail (You)
E-mail (Your Organisation)*
Internet Links*

All the above information marked * will be made available by the Network to the general public unless you place a cross in the last column

Membership Rates: April 2008 – March 2009

· Annual Membership £75 · One free place per member/member organisation at each of the 4 Network Days · Additional member places at each of the 4 Network Days charged at £15 · Non-members attendance at Network Days £25

Payment is enclosed
Please invoice me
I require a receipt

PTO

The Midlands Mediation Network is…

…an inclusive forum of interested parties committed to working together to raise the profile of mediation as a positive means of resolving conflict. The forum will act to ensure the effective development and sharing of information and good practice within all aspects of mediation across the East and West Midlands

The Midlands Mediation Network aims to…

· Identify and meet the individual aims of all members

· Develop professionalism of local/regional service delivery and develop agreed practice standards across the region

· Provide clearly focussed, relevant and accessible support to all members

· Promote and provide an opportunity for the exchange of ideas, knowledge and experience

· Act as a means of promoting mediation locally and regionally

· Ensure that individuals, communities and other agencies are educated as to the process and benefits of mediation

· Ensure effective liaison between the network and its local services with external agencies, other professions and other relevant structures and networks

· Maintain and promote the importance of independence of local services and mediators

Declaration

I have read the information above and will work in partnership with the Network to the above aims.

Print Name

Signed

Date

Please return this form as an attachment to talk2us@midlandmediationnetwork.co.uk

or by post to Owen McMillan DACHS, Brierley Hill Library, High Street Brierley Hill DY5 3ET