Free Consent to Mediation - New Hampshire

UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE

SAMPLE
v. Civil No. _______________

CONSENT TO MEDIATION

The parties in the above-captioned matter agree that ___________________________ is an acceptable mediator. It is further agreed that both counsel and parties will participate in good faith and shall cooperate with the mediator. The parties have agreed to pay (directly to mediator) the $____ hourly rate as follows: _______________________________________________________ _______________________________________________________ _______________________________________________________

_____________________________ Counsel for Plaintiff Date _____________________________ Counsel for Defendant Date

______________________________ Plaintiff Date ______________________________ Defendant Date

(Form to be sent directly to Mediator­DO NOT FILE WITH COURT)