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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 A [Senior Issues, Health Care, and Family] ___ 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] ___ Cluster E [Commercial, Consumer and Courts]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. January 2006)
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