Application For Membership On Panel Of Neutrals | Pdf Fpdf Doc Docx | Wyoming

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Application For Membership On Panel Of Neutrals | Pdf Fpdf Doc Docx | Wyoming

Application For Membership On Panel Of Neutrals

This is a Wyoming form that can be used for Alternative Dispute Resolution within Federal, District Court.

Alternate TextLast updated: 9/14/2006

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UNITED STATES DISTRICT COURT FOR THE DISTRICT OF WYOMING APPLICATION FOR MEMBERSHIP ON PANEL OF NEUTRALS Application is made for membership on the neutral panel with the United States District Court for theDistrict of Wyoming as provided for by the Local Court Rules. Name:______________________________________________________________________________ Firm Name:__________________________________________________________________________ Office Address:____________________________________________Tel. No.____________________ ____________________________________________________________________________________ (City) (State) (Zip) ATTORNEY NEUTRALS 1. Date admitted to the Wyoming State Bar: ______________________ WBA No._____________ 2. Are you a member in good standing of the Wyoming State Bar? ______Yes _____ No 3. Have you ever been a party to any legal proceedings, civil or criminal, charging you with moral turpitude or commission of a crime; or been disbarred, suspended from practice or otherwise disciplined by any court or administrative body; or have any proceedings been instituted against you in any court, administrative body, bar association or grievance committee; or have you ever been refused admission to any Bar of Court? _____ Yes _____ No If yes, please attach an affidavit of explanation. 4. Date admitted before the bar of the United States District Court for the District of Wyoming: ______________________________________________________________________________ 5. Other Court/Bar Professional Associations:___________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ <<<<<<<<<********>>>>>>>>>>>>> 26. Check the areas of legal practice or experience which best describes the majority of your legal practice and indicate the number of years of experience in each: Admin Law ____ years Criminal ____ years Medical Malpractice Antitrust ____ years Civil Rights ____ years Asbestos ____ years Employment ____ years ____years Banking ____ years Areas_______________ Oil & Gas ____ years Bankruptcy ____ years 1983 ____ years Patent/Trademark/ Business/Commercial Debtor/Creditor ____ years Copyright ____ years ____ years Environmental Law Speciality:_____________ Computer Law ____ Personal Injury ____ yearsyears ____ Contracts ____ years Insurance ____ years years Construction ____ years Labor ____ years Products Liability ____ years Securities ____ years Other, specify: ______________________________________________; _____ years THE APPLICANT SHALL PROVIDE A COMPREHENSIVE WRITTEN DESCRIPTION OF HIS/HER LEGAL PRACTICE AND EXPERTISE IN EACH AREA CHECKED. ADR TRAINING COMPLETED 7. a. Hours of ADR training completed_______________________________________ b. Date(s) of training, course provider and course content______________________ _____________________________________________________________________ _____________________________________________________________________ c. Have you ever been observed by another trained neutral (not during training)? ______ Yes ______ No; When________________; Where_____________________ Explain______________________________________________________________ ADR EXPERIENCE 7. Number of ADR Proceedings held to date_________ Describe________________ ____________________________________________________________________ 8. References (ADR Experience)____________________________________________ 9. References (Other)_____________________________________________________ FEES 10. Describe and list the reasonable fees that you will charge the parties for your services to conduct ADR: ____________________________________________________________________ _____________________________________________________________________<<<<<<<<<********>>>>>>>>>>>>> 311. Are you willing to accept cases for mediation for a reduced fee or pro bono? ______ Yes ______ No I certify that the foregoing is true and correct. ___________________________________________________________________ Date Applicant RETURN COMPLETED APPLICATION TO: United States District Court Attention: Deb Birge, ADR Administrator P.O. Box 268 Cheyenne, WY 82003

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