Membership Information

If you are interested in becoming a member, please complete the following application and return with your check/money order in the amount of $25.00 to: Maryland Chapter of ACR, Post Office Box, 3873, Crofton, MD   21114-3873

Name:  _______________________________________________________________

Organization: _______________________________________________________________

Address: ___________________________________________________________________

___________________________________________________________________________

Telephone: _________________________________________________________________

                        (Day)                                                     (Evening)

Fax: _____________________________      E-mail: ________________________________

Area of interest:   (Please select one)

___ Cluster B [Workplace and Organizational Conflict Management]

___ Cluster C [Restorative Justice, Community/Youth and Environmental Public Policy]

___  Cluster D [International, Education (K-12 and University), Ethics and Training]

Are you a member of National ACR?     ”  Yes           ”  No

Referred by: _______________________________________________________________

Comments: ________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Please note that the information provided above will be included in the MD Chapter of ACR’s membership directory.  If there is information that you do not want included, please note accordingly.

(Rev. 2010)