SETTLEMENT WEEK
MEDIATOR VOLUNTEER FORM
Monday, November 30, 2009 thru Friday, December 4, 2009
LAKE COUNTY COMMON PLEAS COURT
I would like to serve as a mediator, or I can be on standby as a mediator, on the following dates:
Whole Day A.M. Only P.M. Only
Monday, November 30, 2009 ( ) ( ) ( )
Tuesday, December 1, 2009 ( ) ( ) ( )
Wednesday, December 2, 2009 ( ) ( ) ( )
Thursday, December 3, 2009 ( ) ( ) ( )
Friday, December 4, 2009 ( ) ( ) ( )
I would prefer to mediate the following types of cases:
Personal Injury( ) Workers’ Compensation ( ) Real Estate ( ) Business Litigation ( )
Other (please specify):
____________________________________________________________
NAME: ______________________________________________________________________________
(Please Print)
FIRM:
_______________________________________________________________________________
ADDRESS: ___________________________________________________________________________
___________________________________________________________________________
PHONE NO: ______________________________FAX NO. _____________________________________
E-MAIL ADDRESS: _____________________________________________________________________
Please indicate if you are willing to work the check-in table: Yes ______ No ______
Please return this form by October 30, 2009 to:
Kristen
Kraus, Esquire
Settlement Week Chairperson
Dworken & Bernstein Co.,
L.P.A.
60 South Park Place
Painesville, OH 44077
Telephone: (440) 352-3391
Facsimile: (440) 352-3469
Email: