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Full names of each party to the mediation and their full contact details;
Party One
Full Name
*
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Phone
*
Lawyer’s Details
*
Party Two
Full Name
*
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Phone
*
Lawyer’s Details
*
Other Information Required
Payment of mediation fees
Shared Equally
Party One
Party Two
Preferred Mediation Venue
Issue to be discussed
Property
Parenting
Both
Preferred Date for Mediation:
*
Date Format: MM slash DD slash YYYY
Booking made by:
*
Contact Number
*
Email
*
Any other related details