COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. UNITED STATES DISTRICT COURT/WESTERN DISTRICT OF WASHINGTON : JUDICIAL SUBPOENA Plaintiff(s) FEDERAL BAR ASSOCIATION ADR COMMITTEE -against: : Application for Appointment as Mediator/Arbitrator : Pursuant to Local Civil Rule 39.1 (As revised pursuant to Order dated October 2, 2000) Defendant(s) : ...................................................... NAME: THE PEOPLE OF THE STATE OF NEW YORK (Please print legibly) WSBA # TOhereby apply for appointment to the Official Register of Qualified Mediators and Arbitrators under Local I Civil Rule 39.1. In connection therewith, I hereby certify and represent to the United States District Court for the Western District of Washington that the information provided below is true and correct to the best of my knowledge and belief. GREETINGS: C I have been a member of the bar of a Federal District Court for at least seven years or have had at least WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before seven years of judicial experience; , the Honorable at the Court located at County of C I am a member of the bar of the U.S. District Court for the Western District of Washington; in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the C I have devoted a substantial portion of my practice to litigation; C I have met the following training requirement which the Court has directed by its General Ortder: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party During thebehalf this immediately preceding for date of this certification, I completed at least 15 hours on whose 36 months subpoena was issued the a maximum penalty of $50 and all damages sustained as a result of your failure to comply. experience calculated as provided in Section 5 of the U.S. District Court for of mediation training or the Western District of Washington’s General Order dated January 17, 1997. (Text of the Court’s General Order is reproduced on the reverse of this application). Witness, Honorable , one of the Justices of the Court in County, day of , 20 C I agree to accept appointment to serve as a neutral on a pro bono basis when appropriate. Date: (Attorney must sign above and type name below) (Signature) Attorney(s) for ************************************************************************************* COMMITTEE RECOMMENDATION: By: BY THE COURT: APPROVE DISAPPROVE Office and P.O. Address (Circle) Date: Telephone No.: Facsimile No.: APPROVE DISAPPROVE E-Mail Address: Mobile Tel. No.: (Circle) American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Chief Judge: Plaintiff(s) -against- Date: : Index No. Calendar No. JUDICIAL SUBPOENA : : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. Text of General Order issued by the United States District Court,:Western District of Washington (IN THE JUDICIAL SUBPOENA Plaintiff(s) MATTER OF CR39.1 MEDIATION TRAINING REQUIREMENTS), dated January 17, 1997. -against: : Pursuant to Local Civil Rule 39.1(b)(2)(D) the following training requirements must be met before an attorney can be included on the register of qualified mediators and arbitrators maintained by the Federal Bar : Association’s Committee on Court Congestion and Administration of Rule 39.1. Defendant(s) : Attorneys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.. . . . . . . . . . . . Appointed .to. the. Register .Prior. to January 1, 1998. On or prior to January 1, . 1998, every attorney desiring to remain a member of the court’s register of qualified mediators and arbitrators shall certify that, during the 36 months immediately preceding his or her certification, he or she has completed 15 hours of mediation training or experience, calculated as set forth below in Section 5. THE PEOPLE OF THE STATE OF NEW YORK 2. Attorneys Applying for Appointment to the Register After December 31, 1997. Effective TO January 1, 1998, every applicant for appointment to the court’s register of qualified mediators and arbitrators shall certify that, during the 36 months immediately preceding his or her certification, he or she has completed 15 hours of mediation training or experience, calculated as set forth below in Section 5. An attorney who makes such certification and meets the requirements of CR39.1(b)(2) shall become a member of the court’s GREETINGS: register effective on January 1 of the year following such certification. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 3. Recertification Every Three Years. After initial certification, each attorney desiring to remain , the Honorable at the Court a member of the court’s register of qualified mediators and arbitrators shall recertify, during each three-year located at County of period after his or her initial certification date, that he or she has completed an additional 5 hours of mediation in room , on the day of , 20 , at o'clock in the noon, and at any recessed training or experience, calculated as set forth below in Section 5. or adjourned date, to testify and give evidence as a witness in this action on the part of the 4. Failure to Provide Initial Certification or Recertification. An attorney’s failure to timely provide the certification required above shall result in the attorney’s removal from the court’s register of qualified mediators andcomply with this subpoena attorney removed contempt register for this reason may liable to Your failure to arbitrators. However, an is punishable as a from the of court and will make you the party for reappointment this subpoena was issued for a maximumrequisite trainingandexperience has been reapply on whose behalf pursuant to the above provisions when the penalty of $50 or all damages sustained as a result of your failure to comply. obtained. 5. Calculation of Mediation Credits. For purposes of meeting the onehours of mediationthe Witness, Honorable , 15 of the Justices of training or experience required under Sections 1,of or 3 above: , 20 2, Court in County, day (a) One continuing legal education credit approved or accredited by the Washington State Bar Association pertaining to training in mediation shall constitute 1 hour of training (Attorney must sign above and type name below) or experience; (b) Observation of one mediation proceeding conducted by an experienced mediator shall Attorney(s) for constitute 2 hours of training or experience; (c) Presiding over one mediation, whether or not conducted pursuant to CR39.1, shall constitute 2 hours of training or experience; Office and P.O. Address provided, however, that no more than 10 of the required 15 hours of training or experience shall be allowed for credits through subsections (b) or (c) set forth above. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. 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