MediatorConsultant
Agreement to Mediate is made on_____/____/_____/
between the followin listed participants.
Client(s) Name:________________________________________________________________________
Client(s) Signature:_____________________________________________________________________
Client(s) Name:________________________________________________________________________
Client(s) Signature:_____________________________________________________________________
Client(s) Name:________________________________________________________________________
Client(s) Signature:_____________________________________________________________________
Co-Mediator(s) Name:__________________________________________________________________
Co-Mediator(s) Signature:_______________________________________________________________
Mediator(s) Name:_____________________________________________________________________
Mediator(s) Signature:__________________________________________________________________
MediatorConsultant:
Charlie Williams
Los Angeles Superior Court ADR Mediator 928 North San Fernando Boulevard, Suite J-122
Burbank, California 91504-4350
Phone: (213) 819-4097
Fax-Phone: (818) 951-3663