Mediation Request

Request to Schedule a Mediation

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Attorney Name *

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Last

Firm Name *

Phone Number *

Client Name or Case Reference *

Email *

Type of Dispute *

If 'other', please explain *

Preferred Date of Mediation *

Length of Medation *

Full Day Half Day Morning Half Day Afternoon Other

Opposing Counsel Name *

First

Last

Opposing Counsel Firm *

Opposing Counsel Phone Number *

Opposing Counsel Email *

Comment *

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