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Request for Assistance
Please use this form to request conciliation assistance. After filling out the address information, complete all of the sections that apply to your situation. Then click the "Submit" button at the bottom of the form and your information will be sent directly to Peacemaker Ministries.
* required information
Title:
-- please make a selection --
Admiral
Ambass. & Mrs.
Ambassador
BGEN
Bishop
Bishop and Mr.
Bishop and Mrs.
Brother
c/o
Cantor
Cantor and Mr.
Cantor and Mrs.
Capt.
Capt. and Mrs.
CDR
Cdr.
Chap.
Chaplain & Mrs.
Cmdr.
CMSGT
Col.
Col. and Mrs.
Commissioner
CWO4
Deacon
Dr.
Dr. & Rev.
Dr. and Dr.
Dr. and Mr.
Dr. and Mrs.
Dr. and Ms.
Dr. and Rev.
Drs.
Elder
Estate of
Father
Fr.
General
H.R.H.
Hon.
Judge
Lt.
Lt. Cmdr.
Lt. Col.
Major
Messrs.
Miss
Monsignor
Mother
Mr.
Mr. and Mrs.
Mr. and Ms.
Mrs.
Ms.
MSG.
Mss.
Pastor
Prof.
Prof. and Mr.
Prof. and Mrs.
Prof. and Ms.
Rabbi
Rabbi and Mr.
Rabbi and Mrs.
Rep.
Rev.
Rev. and Mr.
Rev. and Mrs.
Rev. Dr.
Rev. Dr. & Mrs.
Rt. Rev.
Rt. Rev. & Mr.
Rt. Rev. & Mrs.
Senator
Senator & Mrs.
Sgt.
Sister
Sr.
The
The Hon.
The Hon. & Mr.
The Hon. & Mrs.
The Rev. Deacon
First Name:
*
Last Name:
*
Email:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
-- please make a selection --
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
F.S. Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Not in USA
ZIP/Postal Code:
*
Phone:
Fax:
Does a relevant contract contain a clause requiring Christian conciliation?:
Yes
No
Uncertain
Type of conflict:
Church/ministry
Marriage/family
Commercial
Criminal
Employment
Personal injury
Other
How did you learn about our ministry?:
Please indicate which information you have read thoroughly.:
Slippery Slope
Foundational Principles
Resolving Conflict through Christian Conciliation
Frequently Asked Questions Regarding Christian Conciliation
Rules of Procedure for Christian Conciliation
Model Mediation/Arbitration Agreement
Standard of Conduct for Christian Conciliators
Fees and Costs for Christian Conciliation
The Peacemaker book
Brief description of conflict:
Has a legal action been filed or is one likely to be filed?:
Who have you asked for advice, and what have you done to resolve this conflict?:
What kind of assistance do you need?: