UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER: v. Plaintiff(s) STIPULATION REGARDING SELECTION OF PANEL MEDIATOR Defendant(s). CHECK ONLY ONE BOX: The parties stipulate that may serve as the Panel Mediator in the above-captioned case. has contacted (Print Name) the Panel Mediator and obtained the Panel Mediator's consent to serve on a pro bono basis for three (3)hours. All parties and the Panel Mediator have agreed that the mediation will be held on and counsel will submit mediation statements seven (7) calendar days (Date) before the session. The parties request that the ADR Program staff assign to the above-captioned case a Panel Mediator with expertise in the following area of law : Dated: Attorney For Plaintiff Dated: Attorney For Plaintiff Dated: Attorney For Defendant Dated: Attorney For Defendant Attorney for Plaintiff to electronically file original document. ADR-02 (08/16) STIPULATION REGARDING SELECTION OF PANEL MEDIATOR American LegalNet, Inc. www.FormsWorkFlow.com