Mediator Panel Application Form - Superior Court Of California - County Of Fresno Page 2

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MEDIATOR APPLICATION PAGE TWO
Professional Affiliations with Dispute Resolution Organizations; list dates.
________________________________________________________________
________________________________________________________________
________________________________________________________________
Areas of Expertise:
Business
______
Construction
______
Employment
______
Environment
______
Healthcare
______
Insurance
______
Malpractice
______
Personal Injury
______
Real Estate
______
Other
______
Foreign Languages in which you are capable of conducting a mediation.
________________________________________________________________
________________________________________________________________
Insurance Carrier__________________________________________________
Address _________________________________________________________
City _____________________________State _________Zip _______________
Phone ___________________________________________________________
Current Reimbursement Rate ________________________________________
Other Relevant Information __________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Signature below certifies that all of the above information is true and correct and
that applicant agrees to adhere to Court Standards of Professional Conduct.
Signature ____________________________ Date _______________________
Return this form and your personal narrative to:
Mari Henson, ADR Administrator
B.F SISK Courthouse
1130 “O” Street
Fresno, CA 93724-0002
Phone: (559) 457-1908 ~ Fax: (559) 457-1691
mhenson@fresno.courts.ca.gov

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