ACR-SC Application
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 ⇒ |
|
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
