Consent To Mediation
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1UNITED STATES DISTRICT COURT
DISTRICT OF NEW HAMPSHIRE
S A M P L E
S A M P L E
S A M P L E
S A M P L E
v.
Civil No. _______________
CONSENT TO MEDIATION
The parties in the above-captioned matter agree that
___________________________ is an acceptable mediator.
It is further agreed that both counsel and parties will
participate in good faith and shall cooperate with the mediator.
The parties have agreed to pay (directly to mediator) the
$____ hourly rate as follows:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_____________________________
______________________________
Counsel for Plaintiff
Date
Plaintiff
Date
_____________________________
______________________________
Counsel for Defendant
Date
Defendant
Date
(Form to be sent directly to Mediator–DO NOT FILE WITH COURT)
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