Conciliation Request Form

Please note: Completing this form is for informational purposes only. By submitting this form, you are requesting that I consider your conciliation inquiry, but I am not committing myself to serving you. Thanks for your understanding!

Name:
Address:
Phone Number:
Fax Number:
Email Address:
Best time to contact you:	(your time zone) Eastern Central Mountain Pacific
Brief Summary of the Conflict:
I have read the Getting Help section of the Peacemaker Ministries website (including the Rules of Procedure for Christian Conciliation).	Initial Here
I have read The Peacemaker by Ken Sande and/or the Basic Principles of biblical peacemaking	Yes No
Brief summary of what you have done to try to resolve this conflict:
What kind of assistance are you looking for from me?
Financial Considerations: I have the financial means to pay for these conciliation services.	Yes No
How did you learn about me and receive my contact information?