College of Texas Mediators
Organization Affiliate
Application
To apply for affiliation with CTM,
mail a completed application to the following address together with a
check made out to College of Texas Mediators to cover your annual dues:
College of Texas Mediators
5041 Trail Lake Drive, Fort Worth,
Texas 76133
Name:
Address:
Phone:
Cell:
Fax:
Email:
Organization: (check one)
_____ membership is limited to mediators and related trainers
who primarily serve citizens of Texas; or
_____exists primarily to offer mediation services and related training
to citizens of Texas.
Year established:
Other information:
I am authorized to seek CTM Affiliation on behalf of the above-named
organization.
Print name and title:
Signature:
Date: