Alternative Dispute Resolution Certification And Selection Form Page 3
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3CASE NUMBER:
SHORT TITLE:
The undersigned party is willing to agree to any of the following forms of ADR at this
time:
Mediation
Early Neutral Evaluation
Non-Binding Arbitration
Binding Arbitration
Voluntary Settlement Conference
Other ________________________
None
I/We certify that I/We have read and understood (or have had explained to me/us) the
foregoing.
Date:_______________________
_________________________________________
Signature of Party
Date:_______________________
_________________________________________
Signature of Party
Date:_______________________
_________________________________________
Signature of Party
Date:_______________________
_________________________________________
Signature of Attorney for Party
Signature(s) of additional party(ies) and attorneys on attachment(s).
NOTE:
All parties must complete, file and serve this form on all other parties and their
attorneys. Attached proof of service must be completed and filed.
PRINT
CLEAR FORM
ALTERNATIVE DISPUTE RESOLUTION CERTIFICATION AND SELECTION FORM
PR-E-LP-002
Page 3 of 3
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