Application To Join The

Maryland Collaborative Practice Council

I hereby apply for membership in the Maryland Collaborative Practice Council (MCPC)

PLEASE PRINT THE FOLLOWING:
Name
Mailing Address
Email Address
Phone #
Fax #
Three counties in which you practice the most
Profession
Number of Years in Practice
Mediation Training (When/Hours/Type)
Provide details of your Collaborative Law training (include dates, location, sponsor and trainers/presenters)
I am a member of the following collaborative practice groups (i.e. IACP and local practice groups) and professional practice groups:

 
I certify that the above information is correct to the best of my knowledge, information and belief, and I agree that I will:

A.	Comply with all rules and procedures of the MCPC
B.	Pay annual dues required for membership in the MCPC. We run on a calendar year. Membership Dues for one year are $125.00 or join for two years for $200.00
C.	Complete a minimum 2-day basic training in Collaborative Practice which meets the standards set forth by the IACP
D.	Attend other educational/seminars on Collaborative Practice during the year
E.	Remain a member in good standing in the professional organization appropriate to my profession, and will provide proof of my status, when requested.

Date:

Click here to verify your digital Signature:

 

We encourage you to become involved by working with a committee. I am interested in serving on the following committees:
	Membership (New Members/Benefits/Newsletter) Karen P. Freed and Alice Dansker Doyle, Chair
	Standards of Practice (Forms/Best Practice Standards) Darcy A. Shoop and Suzy L. Eckstein, Co-Chairs
	Education (Symposium/Training) Jolie G. Weinberg and Karen Robbins, Co-Chairs
	Public Information (Website/Community Outreach/Speakers Bureau/Brochure) George P. Collis, Chair
	State Liaison (Brochure/Bar Association) Ronald B. Bergman, Chair
	Financial (Budget/Financial Planning) John A. Faggio, Chair

 
Please make checks payable to: MCPC and mail to:

The Collaborative Law Group
c/o Gail Dunworth
3440 Ellicott Center Drive, Suite 103
P.O. Box 415
Ellicott City, MD 21041