First Name

Last Name

Email Address (that you use for your AAM membership) *

1. I desire to continue my AAM membership.

Select one of the 3 below: *

I have conducted at least five (5) mediations or a combination of mediations and observations in the last calendar year, including Settlement Week mediations and pro bono mediations (for each calendar year following the third anniversary of my admission to AAM).

I am within my three year anniversary of my admission to AAM. (Within the first three years of membership the requirement for 5 mediations per calendar year will be waived. All other requirements must be met.)

Limited Membership: I wish to continue my AAM membership within the Limited Membership Category. Please indicate "limited" by clicking the box beside your signature below. Limited membership is open to AAM members who cannot satisfy the five-mediation renewal requirement due to family commitments, career opportunities, or other circumstances. Limited members must satisfy all other requisites for continuing membership.

2. Members reporting less than 100 mediations (in your mediation history) who have not conducted at least 25 mediations in the last calendar year must agree to the following:

You need to check (a), (b), or (c) - unless this does not apply to you for one of the two reasons indicated. If not applicable, please check the reason why. *

(a) completed one (1) mediation observation with an AAM member.

(b) I have viewed the AAM observation video; (these videos may be selected on the AAM website under Events and Trainings: AAM Mediation Observation Videos [See http://www.attorney-mediators.org/mediation-observation-videos] for viewing on your computer).

NOT APPLICABLE - I am reporting more than 100 mediations (in my mediation history).

NOT APPLICABLE - I have selected Limited Member.

3. In accordance with the membership renewal requirements of AAM, I certify that I have:

Please check ALL that apply *

I have completed five (5) MCLE hours relating to ADR in the last calendar year, which may include self-study hours.

I have made myself available for two (2) pro bono mediations this year (if requested by a Judge or other court official). (Although you may not have conducted pro bono mediations, you may check this if you have made yourself available for pro bono mediations.)

I have complied with all ethical standards promulgated by AAM. (Ethical standards for AAM members are posted on the AAM website.)

I am willing to participate in any grievance/feedback procedures established by AAM. (AAM Grievance procedures are posted on the AAM website.)

4. Insurance coverage requirement: (Please read and answer carefully as this is required by our insurance carrier).

Do you know of any circumstance, act, error, omission, or personal inquiry that could result in a claim or suit against you or AAM arising out of the conduct of arbitration proceedings or dispute resolution services? If your answer to this question is Yes, contact the AAM office with details of the circumstance, act, error, omission or personal inquiry information. *

Yes

5. I certify that I meet or exceed all of the aforementioned requirements for the AAM membership, and to the best of my knowledge, all information in my profile is true and correct. By my signature below, I also agree to adhere to these qualifications and I fully acknowledge that I am being granted membership renewal based on acceptance of these qualifications.

Please choose one *

Agree

Disagree

6. Please sign your name in the space provided.

Your Signature *

Clear

Signature Date *

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