ANNUAL MEMBER DISCLOSURE FORM

By submitting my dues and this signed form, I attest that I:

1. Had no more than two unexcused absences from the general membership meetings this prior year. Verified attendance at one Fireside Chat may be substituted for an unexcused absence. Written notice and explanation must be submitted to the Co-Chairs prior to the meeting for consideration of requests to be excused.

2. Participated in or observed at least one collaborative case (including pro bono) in the last 24 months. If this is an even numbered year, please complete the following for one case in the past 24 months prior to June 1 of this year:

OR

If you participated as an observer, please list the following for one case:

3. Attended at least four (4) days of continuing education in collaborative practice, conflict resolution or interest-based negotiations in the past 24 months. (Complete only in even numbered years.)

Please provide the name, date of attendance, location and length of all continuing education courses you have attended within the prior 24 months in the areas described above.

4. Agree to and reaffirm the mission of TBACP, as follows:

• (a) To educate the public about the Collaborative Process, publicize that process and its benefits; and,
• (b) To encourage its consideration and use for the solution of disputes and conflicts, including, but not limited to, Dissolution of Marriage actions, other family disputes, and other legal matters and conflicts; and,
• (c) To train professionals to effectively provide the Collaborative Process as an option to the public to avoid litigation and the financial and emotional expenses that frequently accompany litigation; and,
• (d) To facilitate public access to information regarding those who are trained in the Collaborative Process; and
• (e) To promote professionalism, and collegiality among its members to create a more effective team capacity in delivering the Collaborative Process to clients.

5. Maintain continuous IACP membership.

6. Maintain professional license(s) and/or designations in good standing and agree to notify the Co-chairs in writing of any change.

7. Agree to notify the Co-chairs in writing of any grievance proceedings which result in private or public reprimand, fines, suspension or loss of licensure/designation.

PLEASE NOTE: By signing below, you understand that your failure to comply with these membership requirements will result in the actions outlined in the Ongoing Membership Maintenance Criteria policy.

If you did not meet one or more of the criteria and would like to provide an explanation, please do so below.