Forms > Approval of Mediator
Approval of Mediator
Approval of Mediator
The undersigned parties have considered the disclosures of interest as made by ________________________ and hereby approve and accept this individual as Mediator in the above-referenced dispute.
AGREED to and executed this _______ day of _________________________, 19 ____ at
BY: ___________________________ BY:____________________________ CLAIMANT (PLAINTIFF) RESPONDENT (DEFENDANT)
[include the typed/printed name and title, if applicable, for each party’s signature]
Agreement of Counsel:
_______________________________ _________________________________ ATTORNEY FOR (Name of Party) ATTORNEY FOR (Name of Party)
(Individual Name of Attorney) (Individual Name of Attorney)
(State Bar Number) (State Bar Number)
(Address) (Address)
(Telephone Number) (Telephone Number)
(Telecopies (FAX) Number, if any) (Telecopies (FAX) Number, if any)
© 1996 The Mediation Center, Inc.
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