OAFM Ontario Membership Application

Please use the following online application form, or send us the requested information by regular mail.

All persons who become an OAFM member, particularly those who are practicing family mediation, agree to abide by the OAFM Code of Professional Conduct.

NEW MEMBERS - Please fill in as completely as possible.

RENEWING MEMBERS - Please fill in any information that has changed in the past 6-12 months.

AccFM's - Please fill in any information that has changed and training which you have received in the past year only.

What type of application is this? New member, or membership renewal?
Pick one:

Please note that due to rising incidences of automated "spam" we must test to see if you are a real human being, therefore please look at the following number displayed below, and enter it into the field marked "Authentication".  If you do not enter this information properly, your form will not be submitted.  Our apologies for this inconvenience.

Authentication
First Name:
Last Name:
Organization:
Position/Title/Function:
Accreditation
Accepted Designations: LL.B, CP.Med, Acc.FM, OAFM.Associate

Business Information:
(as will appear on the online directory, for Associate or Accredited Members only)
Street Address:
City:
Province/Postal Code:  
Business Tel #:
Email Address:
Website: http://

Home Information:
(internal admin use only)
Street Address:
City:
Province/Postal Code:  
Home Tel #:

Preferred Mailing Address:
Business   Home
Preferred Billing Address: Business   Home
Birthdate: (YYYY-MM-DD)  

 Gender:

 


Type of Membership:
membership type descriptions
 
Payment Information:
Payment Type  



Volunteer/Interests:
Board and/or Committees Conference
Public Education Government Relations
Legal Reform & Legislative Change Membership Services
Newsletter Regional Groups
Public Speaking Standards & Certification
Training

Affinity Groups:
(Including any FMC/Provincial/Regional networking, committees,
groups that you are involved with)
Are you currently providing mediation service to the community?
Number of years practicing mediation:
Do you want to be included in the online Mediator Service Directory? (for Associate and Accredited Members only)
Do you want to provide mediation training?
Do you provide internship, mentoring or supervision opportunities?
Are you a judge?
Are you a policy maker?
Professional Setting
Church Court Based
Government Law Office
Non Profit Agency Private Practice
Other:  
Orientation
Administrator Business Person
Civil Servant Clergy
Law Enforcement Lawyer
Lay Person Paralegal
Physician Psychologist
Psychiatrist Social Worker
Therapist/Counsellor Teacher
University Psychiatric Nursing
Other:  
Other Services Provided
Arbitration Credit Counselling
Family Counselling Individual Counselling
Legal Counselling Marriage Counselling
Parenting Education Survivors of Sexual Assault
Family Violence Counselling Assessments
Parent Coordination Separation
Divorce Parenting Plans
Other:
Issues Mediated
Adoption Victim/Offender Relations
Child Welfare Small Claims
Commercial Community
Environmental/Land Use Personal Injury
Organizational Parent-Teen Relationships
School/Children Relations Separation & Divorce
(Access & Custody)
Separation & Divorce
(Financial & Property) 		Separation & Divorce Comprehensive
Other:
Languages That You Provide Services In
English Spanish
French German
Hebrew Hindi
Hungarian Italian
Polish Punjabi
Other:
Education
Degree Institution Year Completed
Mediation Training
Name of Courses Instructor # Hours Date Completed
AccFM's - Please fill in any information that has changed and training which you have received in the past year only.

Declaration:
By submitting this information for application to become a member of OAFM, I hereby agree to adhere to the organization's Code of Ethics.

Signature:
(e-Signature when the "Apply" button is clicked):

 

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