ADR Panels Renewal Form

Enter Any Changes to Your Public Information:

*Email Address

*First Name

*Last Name

*Do You Wish to Continue Serving on the Riverside Superior Court ADR Panel(s)?:
I wish to continue serving on the Riverside Superior Court ADR Panel(s)
I request that my name be removed from the Riverside Superior Court ADR Panel(s)

*Address

Suite/Apt/Unit

*City

*State

*Zip Code

Contact Information

*Phone

Alternate/Cell Phone

Fax

*Will You Accept:
Random Assignments and Stipulations
Stipulations Only
Please Note: If you choose to receive stipulations only, you are still responsible for satisfying the required three (3) mediations per year to remain on the panel.

*Case Types Accepted / Subject Matter Expertise (At least one required - check all that apply)

Accounting

Business

Construction

Conservatorships / Guardianships

Contract

Elder / Dependent Abuse

Employment

Environmental

Family Law

Insurance

Intellectual Property

Landlord Tenant / Neighborhood

Legal Malpractice

Medical Malpractice

Personal Injury

Probate

Product Liability

Public Agency

Real Property

Securities

Wills / Trusts

Other

Representation

Please enter your best estimate of your overall representation types
Percentages must be whole numbers that add up to 100%

Plantiff Representation
Percentage: %

Defendant Representation
Percentage: %

Bar Information

*CA Bar Status
Active
Retired
Not A Member

*CA Bar Number

*Date Admitted

*# of Years of Active Bar Membership

*Have you taken at least 3 hours of continuing mediation training/education per year since becoming a panelist?:
Yes
No

*Has any state bar taken disciplinary action against you?
Yes
No

*Please List All Judgments Adverse to You Within the Last Ten (10) Years:

*Please List All Pending Litigation to Which You Are a Party:

*My Hourly Rate is:

*My Rate Per Day is:

*My Rate Per Half-Day is:

* I have read and am familiar with Local Rule 3275 (pdf ) and its requirement that all required attendees appear in person at the mediation, unless the mediator finds good cause exists for a telephonic appearance (e.g., medical emergency).

Please review your online profile on the panels to confirm it is current. Submit any changes to items not included in this renewal form to: ADRDirector@riverside.courts.ca.gov.

* I have reviewed my online profile, and have requested all necessary updates.

I certify that the above is true and correct to the best of my knowledge, that I am the person who this profile belongs to, and want these changes to be made:
Date:
*Signature:
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ADR Renewal Form

Your public profile information should have auto-populated if you clicked the link we emailed you in the renewal notice.

If you came to this page without the link or do not see your info below, try searching for the email associated with your public profile.

If neither of these methods work, please contact ADRDirector@riverside.courts.ca.gov.

*Email is Required

*First Name is Required

*Last Name is Required

*A Choice of Continue or Remove is Required

*Address is Required

*City is Required

*State is Required

*Zip Code is Required

*Zip Code Failed US/Canada Validation

*Phone Number is Required

*Response is Required For: Will You Accept Random Assignments?

*Max number of random assignments must not be blank if accepting

*At Least One Subject Matter is Required

*Other field must not be blank if checked

*Representation Percentages Must add up to 100%

*Bar Status is Required

*Bar Number is Required if Active or Retired

*Bar Date Admitted is Required if Active or Retired

*# of Bar Years Active is Required if Active or Retired

*Yes or No is Required for: Have you taken training?

*Yes or No is Required for: Has a state bar taken discilpinary action?

*If Yes, Explanation is Required

*List of Adverse Judgments is Required - Put N/A or None if Not Applicable.

*List of Pending Litigation is Required - Put N/A or None if not Applicable.

*Dollar Value is Required

*Dollar Value is Required

*Dollar Value is Required

*Reading and Accepting Local Rule 3275 is Required

*Reviewing Online Profile is Required

*Cert Date is Required

*Certification Signature is Required