CONFIDENTIAL MEDIATION BACKGROUND INFORMATION FOR MEDIATION OFFICE REVIEW ONLY Submit this form directly to the Mediation Office. Do NOT file it in the clerk’s office or otherwise disclose it to the court or to other parties. Case Name: Case No.: 1. Please identify your client(s) and provide contact information for each lawyer who will participate in the mediation conference. If more than one attorney is involved, the attorney with the most direct relationship with the client is required to participate in the conference and should be listed as Lead Mediation Counsel below. Client Names(s): Appellant Appellee Other Details: Lead Mediation Counsel: Name: Firm Name: Address: Telephone*: E-mail: Fax: Other counsel who will participate on behalf of your client: Name: Firm Name: Address: Telephone*: E-mail: Fax: 2. Identify each client or client representative, if any, who will participate in the mediation conference. If they will not be on the line with you, please list the telephone number where they can be reached: Name: Position: Telephone*: *The mediator will call all mediation participants, so please provide each person's direct dial number if available. If not, please provide the best number at which each participant can be reached. You are reminded that cell phones are not permitted. Page 1 of 2 Return by e-mail to teresa_mack@ca6.uscourts.gov or CA06-mediation@ca6.uscourts.gov or fax (513/5647349), at least five working days prior to the mediation conference, to the attention of Teresa Mack, Mediation Administrator. American LegalNet, Inc. www.FormsWorkFlow.com Rev 1/11 CONFIDENTIAL MEDIATION BACKGROUND INFORMATION FOR MEDIATION OFFICE REVIEW ONLY Submit this form directly to the Mediation Office. Do NOT file it in the clerk’s office or otherwise disclose it to the court or to other parties. CONFIDENTIAL INFORMATION This information will not be shared with other parties or their counsel. It is intended to help the mediator more effectively assist you in assessing prospects for settlement generally, and then, if warranted, by steering negotiations toward solutions that may satisfy the parties' interests. Please be as thorough and candid as possible. 1. Please state all specific interests and concerns, other than monetary, which you think should be taken into account in considering resolution of this case:* 2. Please identify any potential obstacles to settlement (on either side). If there have been prior settlement or mediation discussions, please provide relevant information that should be taken into account:* 3. Please provide any other information, comments, or insights to assist the mediator in understanding this case, the underlying dispute, and other issues relevant to settlement efforts:* * If additional space is needed, please continue the responses on a separate page. Please e-mail this form and any continuation pages to the Mediation Office as a single pdf document (see e-mail instructions below). Page 2 of 2 Return by e-mail to teresa_mack@ca6.uscourts.gov or CA06-mediation@ca6.uscourts.gov or fax (513/5647349), at least five working days prior to the mediation conference, to the attention of Teresa Mack, Mediation Administrator. American LegalNet, Inc. www.FormsWorkFlow.com Rev 1/11