Appellate Mediation Agreement Form
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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
New Hampshire Supreme Court
Court Name:
Case Name:
Case Number:
APPELLATE MEDIATION AGREEMENT FORM
Name of Party Filing Form:
Counsel for Party Filing Form: __________________________________ Bar Number:
Phone Number:
Fax Number:
E-mail Address:
List of other parties or counsel:
Phone numbers and/or e-mail addresses:
Phone:
E-mail:
Phone:
E-mail:
Phone:
E-mail:
Phone:
E-mail:
Have you contacted each party or their counsel to determine whether they agree to attend mediation?
YES
NO
If you answered YES, do all parties or their counsel agree to mediate?
YES
NO
I hereby certify that on or before the date below, copies of this form were served on all parties to the
case in accordance with Rule 26(2).
Date
Signature of Party or Counsel
Return form to:
Office of the Clerk
New Hampshire Supreme Court
1 Charles Doe Drive
Concord, New Hampshire 03301
NHJB-2614-SUP (07/09/2013)
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