MEMBERSHIP APPLICATION Membership Level change You have selected the VaCP Membership Dues - Renewal membership level. The price for membership is $135.00 now. Membership expires after 12 Months. Do you have a discount code? Click here to enter your discount code. Discount Code Account Information Already have an account? Log in here Username NOTE: This application is for NEW members to join. If you are a current or former member, to renew your membership, click here to login first. I hereby apply for membership in the VaCP. Please complete the entire application. I agree to maintain current contact information on my profile and consent to receiving email correspondence periodically regarding my membership status, trainings or messages from the Executive Council or Administrator of the VaCP for the duration of my membership in the VaCP. I agree to provide a description of my professional education and training in Collaborative Practice on my Member Profile. Any type of training may be entered on your Member Profile, however, only Collaborative type training will count towards fulfilling training criteria. I agree I will comply with all the requirements of the VaCP and that I will pay dues ($135) assessed annually. Username * Password Confirm Password E-mail Address Confirm E-mail Address Full Name LEAVE THIS BLANK More Information First Name * Last Name * Address * Firm Name City * State * Zip * Phone * Fax Other Office Locations Select Your Profession Select Your Profession Lawyer Lawyer/Mediator Mental Health Professional Mental Health Professional/Mediator Financial Professional Financial Professional/Mediator Affiliate members Associate Retired Legal Associate Retired Financial Associate Retired Mental Health Associate Student * IACP Profile Link () Professional Education Professional License * Htmlsection Practice Groups & Individuals Collaborative Divorce Professionals of Roanoke Collaborative Divorce Solutions of the Virginia Peninsula Collaborative Divorce Solutions of Tidewater Collaborative Professionals of Northern Virginia Collaborative Professionals of Richmond Collaborative Professionals of the Shenandoah Valley Loudoun/ Western Fairfax Collaborative Professionals (sub-group of CPNV) Virginia Collaborative Professionals of Lynchburg Southwest Virginia Collaborative Divorce Professionals Other/Individual Member Htmlsection CertificationAs a professional holding myself out as a Collaborative Professional: I understand the VaCP corresponds with its members via email and agree to receive emails about my membership and training events at the email address I have listed on this application. I have read the IACP Minimum Standards for Collaborative Practitioners and my professional credentials and additional specialty training comply with these requirements. I specifically certify compliance with the following such provisions: I am currently licensed/ certified in one of the professions below; I will remain a member in good standing, and I will provide proof of my status if requested. Approved licenses/certifications are: Attorney at Law J.D. LL.B. Mental Health Professional Ph.D. Psy.D. Ed.D. L.E.P. LCSW LPC LMFT Psychiatrist Financial Specialist CFP® CPA ChFC I have read the IACP Minimum Standards for Collaborative Basic Training. I certify: As a lawyer,I have completed a Two-day Collaborative Law Training, a Two-day or Three-day Collaborative Team Training. Initial Training Year Course Title Instructor Hours As a mental health professional or financial specialist, I have completed 12 hours of basic interdisciplinary training. Initial Training Year Course Title Instructor Hours Initial Training Year Course Title Instructor Hours I have thirty (30) hours or more training in client, facilitative conflict resolution such as basic mediation training (interest-based, narrative, transformative). 30-hr Training Year Course Title Instructor Hours Add More Or I commit to receiving thirty (30) hours or more of such training no later than twenty-four months from the date of this initial VaCP application and will promptly provide the details of such training(s) on my VaCP member profile upon completion. I have additional trainings totaling fifteen (15) hours or more in interest-based negotiation, communication skills training, intermediate collaborative training, advanced collaborative training, basic professional coach training. 15-hr Training Year Course Title Instructor Hours Add More Or I commit to receiving fifteen (15) hours or more of such training no later than twenty-four months from the date of this initial application and will promptly provide the details of such training(s) on my VaCP member profile upon completion. I have met the additional training requirements for my profession as set forth in the IACP Minimum Standards for Collaborative Practitioners or I will obtain such additional training as soon as possible. I have read the IACP Ethical Standards for Collaborative Practitioners and comply with these practice requirements. I have and will maintain current professional liability or E&O insurance for the duration of my VaCP membership. I commit to receiving at least four (4) hours of basic, intermediate, or advanced collaborative continuing education each year and understand that only trainings of the type specified above will satisfy this requirement. [This criteria may be fulfilled by attending one or more trainings to achieve an aggregate of at least 4 hours.] Annual 4-hr Training Year Course Title Instructor Hours Add More Choose Your Payment Method Pay with PayPal Pay by Check Processing... You must agree to each statement above to continue.
