Information Form: Organization

The information provided on this form will be used in accordance with the confidentiality provisions set forth in Rules 16 and 17 of the Rules of Procedure for Christian Conciliation, for purposes of case administration and conciliator selection. This information will not be provided to other participants or to an arbitrator; a copy will be provided to the mediator if pursuing mediation or mediation/arbitration.

Date Completed:

Your Name:

Name(s) (Please list all organizational representatives to whom communication should be copied):

Name of Organization:

Contact Information: (Addresses and telephone numbers at which we may contact you regarding this dispute and conciliation)

Email:

Mailing Address:

City:

State:

Zip/Postal Code:

Country:

Daytime Phone:

Evening Phone:

Fax:

Referred by:

Who lives:

Religion (check boxes that apply):

None
Christian
Jewish
Agnostic
Other

Do you believe in God?

How often do you read or study the Bible?

What is your opinion of the Bible?

I don’t know enough about the Bible to have an opinion
It is a book that contains helpful principles that I am free to follow or disregard as I think best
It is a book that was inspired by God and contains helpful principles, instructions, and commands that I should follow regardless of my feelings or preferences.
Other

Name of Church:

Pastor:

Church Address:

City:

State:

Zip/Postal Code:

Country:


If you are consulting with an attorney about this dispute and request us to send the attorney copies of correspondence, please provide the follow Section:

Attorney:

Attorney Address:

City:

State:

Zip/Postal Code:

Country:

Has a legal action been filed? If yes, list date and action:


Information About the Party With Whom You Are in Conflict:

Name:

Name of Organization: (if applicable)

Mailing Address:

City:

State:

Zip/Postal Code:

Country:

Phone:

Fax:

Email:

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