Mediators Membership This field is hidden when viewing the formPost Title • $325 first year/$375 second year includes CD Cal Profile and access to CP Cal professional site • Mediators must have a professional license (MHP, Attorney, CDFA, etc.); membership depends on maintaining professional licensure in good standing • Members must have at least a 30- hour mediation training • Must attend one Divorce Option workshop within first year • Profile can list geographic area you serve and/or statewide • Application requires the signature of two existing CP Cal Professionals • CP Cal encourages all Mediator members to join a Practice Group but not requiredFirst Name(Required)Last Name(Required)Local Practice Groups You Belong ToCP Cal encourages all Mediator members to join a California Collaborative practice group, but it is not required.Email Address(Required) Website Phone(Required)FaxBusiness Street Address(Required)Street Address 2City(Required)State(Required)Zip(Required)Profession(Required)License/Certificate No.Mediator SpecialtiesYour PhotoAccepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 15 MB. Photos will need to be large enough to fill the required area (300pixels by 300pixels).Section TwoMinimum qualifications to be a Mediator of CP Cal.I hold a California professional license in good standing (if applicable) as aIssued byIssued on License NumberExpiration Date Disciplinary Actions(Required) I have not been subject to public reproval or discipline in my field. I have been subject to public reproval or discipline in my field. I have the following background, education and experience in that further qualifies me as a Mediator SpecialistClick the Plus sign (+) on the right to add another field. Add RemoveI have completed, at least a 30- hour mediation training, I will provide CPCal with evidence of completion.Click the Plus sign (+) on the right to add another field.Offering OrganizationPresenter’s NameDate Add RemoveRequirements(Required) I agree to adhere to all requirements for membership as a Mediator Specialist as follows • Comply with all rules and procedures of CP Cal, including the requirement to withdraw in the event the collaborative process breaks down and judicial litigation is initiated. • Adhere to the terms of CP Cal’s Guidelines and Principles, and Stipulation and Order Re Collaborative Law. • Adhere to the terms of the Protocols/Guidelines of CP Cal. • Allow the publication of my name on CP Cal publications (e.g. website). • Participate in the marketing, promotional and educational efforts of CP Cal. • Remain in good standing as a licensed professional in my field (if applicable) and notify CP Cal immediately if I become subject to public reproval or discipline; • Furnish non-confidential information about my collaborative law cases for CP Cal statistical and evaluation purposes.SponsorsYou must include the contact information for two sponsors who are members of CP Cal.Sponsor 1 Name(Required) First Last Sponsor 1 Email(Required) Sponsor 1 Phone(Required)Sponsor 2 Name(Required) First Last Sponsor 2 Email(Required) Sponsor 2 Phone(Required) Δ