Alternative Dispute Resolution Information

Mediator Info

First Name:

Last Name:

Company Name:

Address 1:

Address 2:



Zip Code:

Phone Number:

Fax Number:


Volunteer Time (optional if you are planning to mediate at the George Allen Sr. Courthouse)

Monday AM:

Monday PM:

Tuesday AM:

Tuesday PM:

Wednesday AM:

Wednesday PM:

Thursday AM:

Thursday PM:

Friday AM:

Friday PM:

Volunteer perferred location for mediation

Court preference (Optional):

Preferred Location:

Volunteer Info

How many mediations are you willing to do?:

What is your training in?:

Experience Level?:

Are you a Lawyer?:

Bar Card Number:

Other Affiliations:

Comments or Notes