American LegalNet, Inc.www.FormsWorkflow.com UNITED STATES DISTRICT COURTSouthern District of AlabamaAPPLICATION FOR FEDERAL PANEL OF NEUTRALS NAME: AGE: LAW FIRM NAME: BUSINESS ADDRESS: MAILING ADDRESS IF DIFFERENT THAN ABOVE: EMAIL ADDRESS: YEAR ADMITTED TO ALABAMA BAR: , TO SOUTHERN DISTRICT OF ALABAMA: ARE YOU REGISTERED IN THE SOUTHERN DISTRICT OF ALABAMA FOR ELECTRONIC FILING? NUMBER OF YEARS IN CIVIL PRACTICE: AREAS OF CIVIL PRACTICE: DATE COMPLETED MEDIATORS TRAINING COURSE: NAME OF ORGANIZATION THAT CONDUCTED THE COURSE: AREAS OF MEDIATION TRAINING: TYPES OF CASES WILLING TO MEDIATE: NUMBER OF CASES YOU HAVE MEDIATED: TYPES OF CASES YOU HAVE MEDIATED: NUMBER OF CASES IN WHICH YOU HAVE REPRESENTED A PLAINTIFF IN MEDIATION: TYPES OF CASES IN WHICH YOU HAVE REPRESENTED PLAINTIFFS IN MEDIATION: NUMBER OF CASES IN WHICH YOU HAVE REPRESENTED A DEFENDANT IN MEDIATION: TYPES OF CASES IN WHICH YOU HAVE REPRESENTED DEFENDANTS IN MEDIATION: PLEASE PROVIDE OTHER INFORMATION FOR THE COURT TO CONSIDER: I WILL BE WILLING TO SERVE AS A MEDIATOR FOR HOURS ANNUALLY WITHOUT PAY.FOR ATTORNEYS: I do hereby certify that I am a member in good standing with the Mobile County and Alabama BarAssociations.SignatureRevised 9/30/05