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?