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

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:

Current 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 CardMailing check to HMA

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

I acknowledge that a "Personal PayPal Account" is not required to pay my HMA dues online. After submitting your current information, you will have a chance to add all the membership dues to your shopping cart. When you click checkout, you will be taken to the PayPal system to process your credit card, please click on the grey box at the bottom that says "Pay with Debit or Credit Card".