MEDIATION DATE REQUEST & CASE INFORMATION
FOR MELANIE E. GRIMES, MEDIATOR
Date Preferred:
Other Possible Dates:
Session Requested:
If half-day requested—any preference?     Morning    Afternoon
Has the date been confirmed by all parties?     Yes    No
Case Name or Style:
Cause No. (if any)
Court (if any)
Brief Description of Matter:
Your Contact Information
Name: (REQUIRED)
Law Firm (if any):
Mailing Address:
Telephone: Fax:
Email (REQUIRED)
Your Client (if applicable): Petitioner/Movant:
Respondent:
Plaintiff:
Defendant:
Intervenor:
Other Parties and Representatives
Name: Petitioner/Movant:
Respondent:
Plaintiff:
Defendant:
Intervenor:
Attorney's Name (if any):  
Law Firm (if any):  
Mailing Address:
Telephone:   Fax:
Email:
   
Name: Petitioner/Movant:
Respondent:
Plaintiff:
Defendant:
Intervenor:
Attorney's Name (if any):  
Law Firm (if any):  
Mailing Address:
Telephone:   Fax:
Email:
   
Name: Petitioner/Movant:
Respondent:
Plaintiff:
Defendant:
Intervenor:
Attorney's Name (if any):  
Law Firm (if any):  
Mailing Address:
Telephone:   Fax:
Email:
Status of Case
In Litigation?:    Yes      No Key Dates:
Payment of Fees:      50/50 Split:    Other:
Comments: