ACR Chicago Membership Application Form

Please check all that apply:
  One Year Individual Membership Fee of $55.00
  One Year Organizational Membership Fee of $110.00
  One Year Full-time Student Membership Fee of $30.00
 

Additional Tax Deductible Gift of:

  $250   $100   $50   Other $ 
This donation will be used to support Programming, online Practitioner Directory, and Website
  I want to be listed on the online Practitioner Directory. Please email or mail my personal username and password.

TOTAL

  $

 

I am:
a new member
a renewing member

I am a current member of ACR National in Washington D.C.

 

I would like to join the following (check all that apply):
Programming Committee
Membership Committee
Public Relations and Outreach Committee
Diversity and Equity Task Force

 

  Demographics Information

Name* Email*
Address*
City* State* Zip*
 
Phone* Fax

To assist us in providing better Programming and Services for our members, we request that you take a moment and provide us with the following information:

I am an experienced dispute resolution professional and work primarily in the following areas:
Mediation Arbitration Training Other please specify
Corporate/Commercial and Tort Labor/Employment
Community Human Resources
Education Faith-Based
Court Social Services
Family/Divorce Other please specify

I am new to the conflict resolution field and interested in partnering with a more experienced dispute resolution professional.
Please note that requirements of the mentoring relationship are flexible and can be decided by the two members. Relationships can range from a few meetings to a longer encounter..

Gender Male Female                
Ethnic Background   African-American   Asian   Caucasian   Hispano/Latino Multiracial    
Age 18-24 years 25-34 years   35-44 years   45-54 years 55+ years    
Education (highest achieved) High school College   Masters   JD PhD Other
Professional background   Counseling   Human Resources Law   Teaching   Training Other