ASSOCIATION FOR CONFLICT RESOLUTION-SOUTH CAROLINA CHAPTER
MEMBERSHIP APPLICATION
CONTACT INFORMATION
| NAME ACR MEMBER? YES ⇒ NO ⇒ | |
| ADDRESS | |
| CITY COUNTY STATE ZIP |
PRIMARY CONTACT?
(CHECK ONE)
| HOME PHONE | |
| WORK PHONE | |
| CELL PHONE | |
| E-MAIL ADDRESS WEBSITE |
ACR-SC Chapter makes the following information available to all members: Name, City, Work/Specialty, Primary Phone, E-Mial, and Web-site. You may request not to include phone, e-mail, or website here:
| INCLUDE PRIMARY PHONE? YES ⇒ NO ⇒ INCLUDE E-MAIL? YES ⇒ NO ⇒ INCLUDE WEBSITE? YES ⇒ NO ⇒ |
YOUR WORK IN CONFLICT RESOLUTION (CHECK ONE)
| PAID FULL-TIME ⇒ PAID PART-TIME ⇒ VOLUNTEER ⇒ STUDENT ⇒ |
WORK AREARS
| Mediator ⇒ System Design ⇒ Abritrator ⇒ Educator ⇒ | |
| Ombuds ⇒ Trianer ⇒ Facilitor ⇒ Program Director ⇒ | |
| Others: Others: | |
| LANGUAGES |
SPECIALTY AREAS
| Civil ⇒ Commerical ⇒ Community ⇒ Construction ⇒ | |
| Court Programs ⇒ Criminal ⇒ Workplace ⇒ Divorce ⇒ | |
| Education ⇒ Environmental ⇒ Family ⇒ Government ⇒ | |
| Health Care ⇒ Online ADR ⇒ Juvenile ⇒ Probate ⇒ | |
| Special Education ⇒ Eldersare ⇒ Others: |
| YEARS IN ADR FIELD: HIGHEST DEGREE HELD: SELF-EMPLOYE? YES ⇒ NO ⇒ |
| EMPLOYER: POSITION: |
REFER BY:_________________________ DATE OF APPLICATION:_________
COMPLETE THIS APPLICATION WITH CHECK PAYABLE TO "ACR-SC CHAPTER:"
Regular Member (also ACR National Member) $35
Affiliate Member (not ACR National Member) $50
Full-time Student or Volunteer $25
MAIL TO: MELISSA LADD/915 FOLLY ROAD, SUITE 0, PMB#3/ CHARLESTON, SC 29412
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