Name*

Firm or Business Name*

Address*

City, State, Zip Code*

Phone*

Email*

Web Site

Select role in the Collaborative Process you are requesting to be renewed as a Fellow or Associate. The Associate level is available for the first two years that you are a member.*

ATTORNEY: I am registered with the ARDC and my licensure is in good standing. ARDC #

FINANCIAL: My CDFA certification is in good standing (provide CDFA Certificate #)

FINANCIAL: My additional certification is in good standing (select appropriate credential)

CFA
CFP
CPA
ChFC
CMA
MBA
EA – or at least
Other (10 years of work experience in the financial industry (e.g., banking, brokerage, insurance, etc.)

MENTAL HEALTH PROFESSIONAL: My clinical licensure is in good standing; select appropriate clinical license designation:

LCSW
LCPC
LMFT
Ph.D.
Psy.D

Practice Region(s)*

You can select more than one.

If other please specify

Which Practice Group Meeting location(s) do you consider to be your primary?*

Please select a Committee(s) or other opportunity for which you would like to volunteer.

To renew in the first calendar year following the year in which a member is approved, proof of the completion of a minimum of six hours of Fellows Collaborative Skills Training (FCST) is required. Please list the title(s) and date(s) of trainings completed*

Starting the second calendar year following the year in which a member is approved, the member must report every other year his or her fulfillment of FCST requirement (minimum of six hours for each year or a total of twelve hours every two years). Title(s)/date(s) of trainings completed in 2020/2021.

I hereby verify that I:

•Have read and agree to abide by CDI's Principles and Guidelines for Collaborative Family Law that are incorporated into CDI's Collaborative Process Participation Agreement;
• Commit to using CDI's Collaborative Process Participation Agreement in its unaltered and original form in all of my Collaborative cases;
• Understand and acknowledge that CDI does not provide any liability, E&O or any other type of insurance to its members, and I agree that I currently have and will maintain an appropriate amount of liability, E&O, and/or any other insurance that is standard for professionals in my field;
• Agree to follow the rules and regulations for use of all forms and promotional materials I purchase or a provided by virtue of my CDI membership;
• Acknowledge and agree that my name may be removed from CDI membership directory, and that my membership in CDI may be terminated at the discretion of the Board of Directors for reasons including, but not limited to, not abiding by the Principles and Guidelines of Collaborative Family Law and/or requirements as set forth by CDI;
• Agree that if my CDI membership is terminated for any reason, I shall cease to use or distribute any forms, lists, or promotional materials I obtained or received authorization for use, solely by virtue of my prior membership in CDI;
• Agree that should a dispute arise regarding my CDI membership, I will first attempt to resolve any dispute through the Collaborative process and/or mediation;
• Acknowledge and agree that, if I am included in the CDI membership directory, the directory information related to me may be distributed at the discretion of the Board of Directors of Collaborative Divorce Illinois, whether that be in hard copy, verbally in response to telephone inquiries, through the Collaborative Divorce Illinois' web site, or otherwise;
• Release Collaborative Divorce Illinois from any claim I may have, now or in the future, regarding anything pertaining to the CDI membership directory;
• Attest that I am a member in good standing of my profession and that all of the information on this application and all of the information that I submit in support of this application is true and accurate.

AGREE TO COMPLY*

First Last

I attest that I am a member in good standing of my profession and that all of the information on this application and all of the information that I submit in support of this application is true and accurate.

Date*

Please add today's date

2022 Membership Fees (enter the amount below). Associate dues rate available for members for the first two years of membership.*

Attorney: $425
Financial: $325
Divorce Coach: $255
Divorce Coach & Child Specialist: $280

If you completed continuing education courses outside of CDI, please upload the certificate(s) of attendance (PDF or Word). Once the documents have been uploaded and this form has been submitted, please remit payment to CDI's PayPal account (admin@collaborativedivorceillinois.org), or mail a check to CDI, PO Box 350050, Elmwood Park, IL 60707.

Drop files here or

Accepted file types: pdf, docx, Max. file size: 50 MB, Max. files: 5.

Comments

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Member Renewal

I hereby verify that I: