USDC/MED-001 | LR 16.6.2 (6/05) Notice of Nomination of Mediator UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF WEST VIRGINIA AT SELECT ONE: NOTICE OF NOMINATION OF MEDIATOR v. CIVIL ACTION Pursuant to the Local Rules of Civil Procedure and this Court’s Scheduling Order, the parties nominate _______________________________________________________ as the mediator for the parties. The parties have agreed on the amount of the mediator’s fee and the responsibility for payment of that fee. The mediator’s mailing address, telephone number, facsimile number, and e-mail address are: Respectfully submitted, ___________________________________ ___________________________________ Name of Plaintiff(s) or Plaintiff(s) Pro Se Name of Defendant(s) or Defendant(s) Pro Se __________________________________________ Counsel for Plaintiff(s) or Plaintiff(s) Pro Se __________________________________________ Counsel for Defendant(s) or Defendant(s) Pro Se ___________________________________ ___________________________________ Date Date American LegalNet, Inc. www.FormsWorkFlow.com USDC/MED-001 | LR ??? (6/05) Notice of Nomination of Mediator ADDITIONAL PARTIES AND COUNSEL: ___________________________________ ____________________________________ Name of Plaintiff(s) or Plaintiff(s) Pro Se Name of Defendant(s) or Defendant (s) Pro Se ___________________________________ ___________________________________ Counsel for Plaintiff(s) or Plaintiff(s) Pro Se Counsel for Defendant(s) or Defendant (s) Pro S __________________________________ Date __________________________________ Date ___________________________________ ____________________________________ Name of Plaintiff(s) or Plaintiff(s) Pro Se Name of Defendant(s) or Defendant (s) Pro Se ___________________________________ ___________________________________ Counsel for Plaintiff(s) or Plaintiff(s) Pro Se Counsel for Defendant(s) or Defendant (s) Pro Se ___________________________________ Date ___________________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com