The Marc Manager Membership Membership Application Form Which Membership grade are you applying for? *SelectSenior Associate Member (SAM)Graduate Associate Member (GAM)Associate Member (AM)Junior Associate Member (JAM)Student Member (SM)Young Mediator Member (YMM)Club Member (Club)General Member (GM)All membership categories are expected to deliver professional services to society through pro bono services and outreach. WASILIANAHUB Mediators engage in programmes to host or participate in through the year.The grade of Senior Associate member is awarded to persons holding executive positions and have contributed towards the advancement of theory, policy and practice of mediation and dispute resolution as demonstrated by qualification, experience. Consideration is made to other factors such as the entity and size of the organization they lead. In addition, the person must show evidence of continuous professional development. Entrance Fee: 2,000 Annual Subscription: 6,000 Total: 8,000 The grade of Graduate Associate Member is awarded to persons who have contributed towards the advancement of theory, policy and practice of mediation and dispute resolution as demonstrated by qualification, experience. The person must show evidence of continuous professional development. In addition, has taken up the experiential programs (TAM). Entrance Fee: 2,000 Annual Subscription: 3,000 Total: 5,000 The grade of Associate Member is awarded to persons who are actively engaged in the practice of mediation and dispute resolution as demonstrated by qualification and experience. In addition, the person must show evidence of continuous professional development. Entrance Fee: 2,000 Annual Subscription: 3,000 Total: 5,000 The grade of Junior Associate Member is awarded to persons who have demonstrate proactive entry into practice of mediation and dispute resolution as demonstrated by qualification, experience. Such person must show evidence of efforts towards continuous professional development. In addition, they are encouraged to taken up the experiential programs (TAM). Entrance Fee: 2,000 Annual Subscription: 1,000 Total: 3,000 The grade of Student Member is open to students in universities, polytechnics, colleges tertiary and other middle level institutions engaged in mediation and dispute resolution study and or practice Entrance Fee: 1,000 Annual Subscription: 500 Total: 1,500 The grade of Young Mediator Member is open to students in universities, polytechnics, colleges tertiary and other middle level institutions trained in mediation and dispute resolution and in practice. A one-year window applies for the first year to other persons who are newly trained in mediation (Certified). Entrance Fee: 1,000 Annual Subscription: 1,000 Total: 2,000 The grade of Club Membership is open to clubs at learning institution. Entrance Fee: 1,000 Annual Subscription: 1,000 Total: 2,000 The grade of General Member is open to persons with interest in mediation and resolution of disputes to receive updates from the network. Entrance Fee: nil Annual Subscription: nil Total: nil Title *SelectMr.Mrs.Miss.HON.ENG.DR.PROF.REV.ARCH.Name *FirstMiddleLastDate of birth *Gender *MaleFemaleID Number/ Passport Number: *Email *Phone *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountryCurrent Place of Work:Current Profession (Expertise): *Highest Level of Education: *Mediation & Resolution Practice Category *Mediator (Other)AdvocateLawyerTraditional Dispute ResolutionNegotiatorAdjudicatorPeace and ReconciliationFacilitatorCounsellorArbitratorConciliatorCertified Mediator (+40 Hours Training)Choose all that apply. Please attach a valid certificatePlease attach a valid certificate *Nearest WASILIANAHUB Branch of Service Kenya: *OtherMombasaIsioloMurang'aLaikipiaSiayaKwaleMeruKiambuNakuruKisumuKilifiTharaka-NithiTurkanaNarokHoma BayEmbuWest PokotKajiadoMigoriLamuKituiSamburuKerichoKisiiTaita-TavetaMachakosTrans NzoiaBometNyamiraGarissaMakueniUasin GishuKakamegaNairobiWajirNyandaruaElgeyo-MarakwetVihigaManderaNyeriNandiBungomaMarsabitKirinyagaBaringoBusiaNearest WASILIANAHUB Branch Globally: *AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweDeclaration *I understand that the membership committee may award a grade that is different to the one claimed and that the committee's decision is final. I declare that the information given herein is correct to the best of my knowledge and belief, and, if selected, I agree to be bound by the rules and regulations of WASILIANAHUB Mediators as they now exist and as may hereafter be altered.Payment Please note that your membership is not valid until you make full payment. Check your Email for details of payment after you apply.NameApply
