Alternative Dispute Resolution Provider Application Form - 2011
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1UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF TEXAS
ALTERNATIVE DISPUTE RESOLUTION PROVIDER APPLICATION
The requirements for listing as an ADR provider for the United States District Court for the Southern District of Texas
are contained in Local Rule 16.4.E. Please answer all questions and return application ONLY between November 1
and January 31.
PLEASE PRINT OR TYPE
Mail four (4) copies of COMPLETED
Name:
APPLICATION and FEE SCHEDULE
attached to:
David Bradley, Clerk
Firm Name: __________________________________________
ATTN: ADR Deputy Clerk
Address: _____________________________________________
P.O. Box 61010
_____________________________________________________
Houston, Texas 77208
Telephone Number: ( )
Fax Number: ( )
E-Mail:
License(s) to practice law:
Date: ______________ State: _____________ State Bar No.: ________________________
Date: ______________ State: _____________ State Bar No.: ________________________
Date Admitted to Southern District of Texas Bar: ____________________
Hours of ADR training in a State Bar of Texas MCLE approved course.
(Please submit written proof from the course sponsor
of your satisfactory completion of the training and the number of MCLE hours for which credit was given.)
Course: ______________________________________________________________________________________
Date: __________________ Sponsor: ______________________________________________ Hours: ______
Course: ______________________________________________________________________________________
Date: __________________ Sponsor: ______________________________________________ Hours: ______
ADR methods in which listing is sought:
Mediation: _________ Mini-trial: _________ Summary Jury Trial: _________ Arbitration: _________
Substantive legal area(s) of experience:
Intellectual Property _________
Property Rights _________
Contracts _________
Real Property _________
Torts _________
Civil Rights _________
Labor _________
Bankruptcy _________
Antitrust _________
Securities _________
ERISA _________
Other (please describe): _________________________________________________________________________
Divisions of the Southern District of Texas where available for ADR practice:
Brownsville _______
Corpus Christi _______
Galveston _______
Houston _______
Laredo _______
McAllen _______
Victoria _______
All _______
(ADR proceedings will normally be conducted in the divisions in which the case is pending. Providers may not charge for travel from the
division where they office to another division to conduct an ADR proceeding without prior approval of the parties.)
Experience as ADR neutral:
Number of cases mediated: _________
arbitrated: _________
summary/mini-trial judge: _________
Other information: ______________________________________________
_____________________________________________________________________________________________________
Do you commit to accept some cases for no fee or a reduced fee? _________
Applicant Signature:
Date:
SDTX-ADR-1
10/12/2011
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