Party Information

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


To complete this information online, please type your information into the fields below and complete all four sections of the form.  At the end of the form, press the "Done" button.  


If you prefer, you may download and print this form.  Simply fill it out and mail the completed form to Ambassadors of Reconciliation, P.O. Box 81662, Billings, MT 59108-1662 or fax to (888) 656-2523.  Please call if you have any questions regarding this form: 406-698-6107.

1. Your Information

Physical Health
Marital Status

If you are consulting an attorney about this dispute, please provide the following information if you would like your attorney copied on correspondence and/or give permission for your reconciler to talk with the attorney.

2. Your Attorney's Information

Has a legal action been filed or is one likely to be filed in this situation?  If yes, give dates and describe action below.

Have you received advice from anyone else regarding this situation?  If yes, give names and dates below.

We have found that religious background can have a significant impact on how one deals with conflict. In order for us to be sensitive to your personal convictions, it is helpful for us to receive the following information.

3. Personal Religious Background

Do you believe in God?
How often do you pray to God?
Do you believe that when you die you will be with God eternally?
Have there been any recent significant changes in your spiritual life?
How often do you study the Bible?
What is your opinion about the Bible?

If you are affiliated with or under the authority of a particular church, please provide the following information.

4. Information about the Other Party

Other Party's Religious Background

If the other party is affiliated with or under the authority of a particular church, please provide the following information.


©2018 by Ambassadors of Reconciliation.