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By signing and submitting this application for status as a Practitioner Mediator designation from the Wisconsin Association of Mediators (WAM), I understand that: 1.) my enclosed check for the $50 application fee is in addition to my annual WAM membership dues ($75); 2.) renewal of my designation after the first year will be in the amount of $35 per year (concurrent years only) and will require evidence of 15 hours of continuing education per three year period. I attest that I have fulfilled all of the following requirements (all must be checked/provided):

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