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Case Type:	Please select one. BUSINESS Breach of Contract Franchise Intellectual Property Partnerships / Corporate Dissolution Securities Unfair Competition Other CONSTRUCTION Bid Dispute Breach of Contract Construction Defects Delay / Disruption Public Works Other EMPLOYMENT Americans with Disabilities Act Breach of Contract Discrimination - age Discrimination - disability Discrimination - gender Discrimination - medical condition Discrimination - national origin Discrimination - pregnancy Discrimination - race Discrimination - religion Discrimination - sexual orientation Discrimination - other Family/Medical Leave Harassment - gender Harassment - national origin Harassment - pregnancy Harassment - race Harassment - religion Harassment - sexual orientation Harassment - other Public Policy Violation Retaliation Unfair Competition Wrongful Termination INSURANCE Bad Faith - Disability Insurance Bad Faith - Property Damage Bad Faith - General Bad Faith - other Coverage Other PERSONAL INJURY Automobile / Automobile Automobile / Pedestrian Automobile / UM or UIM Boat Catastrophic Injuries Civil Assault Defamation Elder Abuse False Imprisonment Food Poisoning Industrial Accident Injury to Reputation Intentional Torts Invasion of Privacy Maritime Premises Liability Products Liability Shooting Toxic Substance Exposure Train Truck Wrongful death Other PROFESSIONAL LIABILITY Accountant Attorney Architect Board of Directors Engineer Financial Advisor Insurance Broker Dentist Pharmacist Physician Other Health Care Provider Real Estate Broker / Agent Other PROPERTY DAMAGE Negligence Subrogation Trespass Other PROBATE & TRUST Breach of Fiduciary Duty Will Contest Other REAL PROPERTY Boundaries Commercial Lease Commissions HOA CC&Rs Mobile Home Park Non-disclosure Other
Have all the parties agreed to mediate?
	Yes   No
If so, have the parties agreed on a mediator?
	Yes   No
If so, which mediator?
	Mr. Markus   Mr. Pantoni
When would the parties like to mediate?
	1-2 weeks 3-4 weeks 5-6 weeks 7-8 weeks Other
Where is the mediation likely to be held?
	San Diego Carlsbad Laguna Nigel Los Angeles Las Vegas Other Escondido Orange County Riverside San Francisco Phoenix
How much time is needed?
	Full Day   Half Day (San Diego County only)
Have all the parties agreed on a fee split?
	Yes   No
If so, what?
How were you referred to our service?
Would you like references?
	Yes   No
Other Comments or Questions: