The Request for Mediation shall include:
Any proposal regarding the qualifications of a Mediator: ____________________________
________________________________________________________________________
Name of the proposed Mediator: __________________________________
List of Mediators that would be qualified to serve in the Mediation of the dispute if the other party or parties also so designated:
_____________________________
_____________________________
The Request must be sent to:
Address:
Fax:
E-mail:
[The accompanying registration fee is payable:
- by cheque to the order of the _______________________
Requestors:
_____________________________
_____________________________