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?

You may print this form and mail it to me if you would prefer. Click here for my contact information.