Member Renewal

HMA Membership goes from June 1 to May 31. If you become a member after January 1 then your membership will go to May 31 the next year.

Annual Dues ……………………………………………….…… $65.00
Full-Time Volunteer Mediator or Retired …..….. $50.00
Full-Time College Student………………………………… $25.00
Corporate Membership …(3 People)…..………….$160.00
(Additional Corporate Members to Original 3) .. $40.00 each
Web Site Referral Listing: (each person) ……… $10.00
Public Servant: (See Below) ……… $30.00

Public Servant (Must meet this criteria to receive discount)

  1. The applicant is employed by a government agency and the CME/CLE will benefit their employment.
  2. The applicant does NOT provide services similar to their job outside the scope of their government employment that provides monetary benefits to the applicant.
  3. The applicant does NOT provide any mediation related services that provides monetary benefits to the applicant.
  4. Title and Place of Employment

ROSTER INFORMATION

The information below will appear in the HMA database and on the HMA web site in the ‘Members Only’ section. (Unless you otherwise state your intention in the comment section below)

Your Name (Required):

Company Name:

Mailing Address (Required):

City, State, Zip:

Business Phone:

Business Fax:

Email (Required):

Home Address:

Phone Number (Required):

Home Phone Number:

Occupation (Required):

Type of Mediation:

Geographic Scope:

College:

Degree:

Post Graduate School:

Degree:

2018 Kansas Supreme Court Approved Mediator (Please Choose)

CivilCoreDomesticJuvenile DependencyParent Adolescent

(Please Check all that apply)

Professional LicensingMarriage & Family TherapistAttorneyClinical Marriage & Family TherapistPsychologistMaster Social WorkerMaster Level PsychologistSpecialist Social WorkerProfessional CounselorOther (Specify)

Specify:

All this Information will be placed on the HMA Web Site ‘Members Only’ Section except for your home address and home phone number.

Unless you have told me otherwise in the comment section below:

Your Comments:

I will be paying by: (Options see below)

Pay by Credit Card Thru PayPalMailing check to HMA

HMA's mailing Address:
P. O. Box 14971, Lenexa, KS 66285

Call or Email HMA to make it easier for you if you are paying for more than 2
people by credit card. HMAOrganization@everestkc.com
HMA # 913-956-7620 Fax # 913-825-3243
HMA needs the Card # & Expiration Date-VISA, MasterCard & Discover