Panel Update Form {ADR-203}

CONTRA COSTA COURT ADR PANEL MEMBER UPDATE Return completed form by email adrweb@contracosta.courts.ca.gov or fax (925) 957-5689 Name: ___________________________________________________________________________ First Middle Last Office Address: ____________________________________________________________________ Street City State Zip Office Phone: ______________________________ E-Mail Address: ____________________________ Assistant Name: ____________________________ Office Fax: __________________________ Website: ____________________________ E-Mail: _____________________________ Hourly fees charged for service as an ADR Panel Member (required per Rules of Court 10.781) $ _______ Calif. State Bar No.: _______________ Other License No. (specify): __________________________ You must meet the CEU requirements every three years; commencing January 1, 2006 or following appointment as a mediator to the court ADR panel. Local Court Rules, Rule 3.201(c)(3) require mediation panel members to attend at least four hours of continuing education related to the practice of mediation. At least 2 hour(s) of that education or training must address mediator ethics, fairness, and bias issues; 1 hour must address issues that may arise for mediators when parties are self-represented, and 1 hour must address general mediation issues (from the mediator's perspective.) MEDIATION Trainer MEDIATION Education Course Title Hours (per requirement) Date mm/dd/yy Meets this requirement (please check one) General SRL Ethics AREAS OF EXPERTISE Auto Tort Auto (Personal Injury) Uninsured motorist Other PI/PD/WD (Personal Injury/ Property Damage/Wrongful Death) Tort Asbestos Product liability Medical malpractice Other PI / PD / WD Non-PI/PD/WD (Other) Tort Business tort/unfair business practice Civil rights (e.g., discrimination, false arrest, disability) Defamation (e.g., slander, libel) Fraud Intellectual property Professional negligence (e.g., legal malpractice) Other non-PI / PD / WD tort Employment Wrongful termination Other employment Contract Breach of contract / warranty Collections (e.g., money owed, open book accounts) Insurance coverage Other contract Real Property Eminent domain / inverse condemnation Wrongful eviction Other real property (e.g., quiet title) Unlawful Detainer Commercial Residential Drugs Judicial Review Asset forfeiture Petition re: arbitration award Writ of mandate Other judicial review Other Probate / Will Contest / Family Conservatorship of Estate Conservatorship of Person Guardianship of Estate Guardianship of Person Property or Tax Issues Trust Issues Will Contest Provisionally Complex Civil Litigation Antitrust / Trade regulation Construction defect Mass tort Securities litigation Toxic / Environmental tort Insurance coverage claims arising from the above listed provisionally complex case types Enforcement of Judgment Enforcement of judgment Miscellaneous Civil Complaint RICO Other complaint (not listed above) Miscellaneous Civil Petition Partnership and corporate governance Other petition (not listed above) Miscellaneous Other Elder Abuse False Imprisonment Family Law Lemon Law Mechanics Lien Sexual Harassment ADR-203 Rev. 6/1/16 American LegalNet, Inc. www.FormsWorkFlow.com