APPLICATION FOR ADMISSION TO ROSTER OF CIVIL ARBITRATORS A separate form must be sent to the Arbitration Administrator of each County in which you wish to serve LAST NAME FIRST NAME MIDDLE NAME FIRM/BUSINESS FIRM/BUSINESS ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER Number of years of legal experience: Name of Group/Organization in which you served as an arbitrator: Other States: Bar Admission Year: New Jersey: Date of Initial Arbitration Training: Counties in which you appear and are willing to arbitrate: I regularly represent: ͜ ͜ Plaintiffs ͜ Defendants Both I have at least seven years’ experience in the following areas and request to arbitrate them (check all that apply): ͜ ͜ ͜ ͜ 502 Book Account 503 Commercial Transaction 506 PIP Coverage 512 Lemon Law ͜ ͜ ͜ ͜ 599 Contract – Other ͜ 610 Auto Neg - Prop 602 Assault/Battery 603 Auto Neglect-Personal Injury 605 Personal Injury I certify that the foregoing statements made by me are true and that I am in good standing in my profession. ______________________ _________________ Signature Date Return this form with a copy of your resume to: Arbitration Administrator of the County See Page 2 for Names and Addresses of Arbitration Administrators Revised 11/1/2011, CN 10507-English page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Atlantic County Arbitration Williams Reynolds Atlantic County Courts Building 1201 Bacharach Boulevard Atlantic City, NJ 08401 609-594-3329 Bergen County Arbitration Madeleine Fernandez Bergen County Superior Court 10 Main Street, Room 115 Hackensack, NJ 07601 201-527-2735 Burlington County Arbitration Patricia A. Spiehs Burlington County Courts Facility 49 Rancocas Road P.O. Box 6555 Mt. Holly, NJ 08060 609-518-2816 Camden County Arbitration Stephen Gladden Camden County Hall of Justice Suite 150 101 South Fifth Street Camden, NJ 08103 856-379-2200 Ext.3080 Cape May County Arbitration Janet Hill Cape May County Superior Court 4 Moore Road, DN 203 Cape May Court House, NJ 08210 609-463-6512 Cumberland County Arbitration Erica Poloff Cumberland County Courthouse Civil Division, Rooms 162-185 Broad and Fayette Streets Bridgeton, NJ 08302 856-453-4358 Essex County Arbitration Crystal Page Essex County Superior Court Historic Court House, Room 103 470 Dr. Martin Luther King, Jr. Blvd. Newark, NJ 07102 973-693-6447 Gloucester County Arbitration Rebecca Bertino Gloucester County Courthouse Civil Case Management 1 North Broad St. Woodbury, NJ 08096 856-853-3228 Hudson County Arbitration Cheryl D'Anna Hudson County Superior Court Civil Division - Arbitration 583 Newark Avenue Jersey City, NJ 07306 201-795-6372 Hunterdon/Somerset/Warren Vicinage Arbitration Reta Wahba Somerset County Courthouse 40 N. Bridge St. Somerville, NJ 08876-1262 908-231-7659 Mercer County Arbitration Kathleen Wardlow Mercer County Civil Case Management 175 South Broad Street P. O. Box 8068 Trenton, NJ 08650 609-571-4454 Middlesex County Arbitration Fee O’Brien Middlesex County Courthouse 56 Paterson Street New Brunswick, N.J. 08903 732-519-3721 Monmouth County Arbitration Laura Larkin Civil Assignment Office Monmouth County Courthouse Monument and Court Streets Freehold, NJ 07728 732-677-4246 Morris County Arbitration Elizabeth Erb Civil Division Manager’s Office P.O. Box 910 Morristown, NJ 07963-0910 973-656-4103 Ocean County Arbitration Kimberly Knapp Ocean Co. Civil Case Processing 206 Courthouse Lane, 2nd Floor Toms River, NJ 08754 732-929-4771 Passaic County Arbitration Denice McNamee Passaic County Superior Court 77 Hamilton Street, 3rd Floor Paterson, NJ 07505 973-247-8198 Salem County Arbitration Jennifer Bates Salem County Courthouse Civil Case Management Office 92 Market Street Salem, NJ 08079 856-935-7510 Ext. 8393 Sussex County Arbitration Luann Callahan Sussex County Judicial Center Civil Division 43-47 High Street Newton, NJ 07860 973-579-3892 Union County Arbitration Cynthia Dawkins Union County Superior Court Civil Arbitration Albender Building, 2nd Floor 1143 East Jersey Street Elizabeth, NJ 07201 908-659-3270 Revised 11/1/2011, CN 10507-English page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com