UNITED STATES DISTRICT COURTSOUTHERN DISTRICT OF TEXASALTERNATIVE DISPUTE RESOLUTION PROVIDER APPLICATIONThe requirements for listing as an ADR provider for the United States District Court for the Southern District ofTexas are contained in Local Rule 16.4.E. Please answer all questions and return application ONLY betweenDecember 1 and January 31. PLEASE PRINT OR TYPEName:E-Mail COMPLETEDAPPLICATION with FEESCHEDULE attached to:ADRAdministrator@txs.uscourts.govFirm Name: Address: Telephone Number: ( ) E-Mail:License(s) to practice law: Date: State: State Bar No.: Date: State: State Bar No.: Date Admitted to Southern District of Texas Bar: Hours of ADR training in a State Bar of Texas MCLE-approved course. (Please submit written proof from the coursesponsor of your satisfactory completion of the training and the number of MCLE hours for which credit was given.)Course: Date: Sponsor: Hours: Course: Date: Sponsor: Hours: ADR methods provider agrees to conduct:Mediation: Mini-trial: Summary Jury Trial: Arbitration: Substantive legal area(s) of experience: Intellectual Property Property Rights Contracts Real Property Torts Civil Rights Labor Bankruptcy Antitrust Securities ERISA Other (please describe): Divisions of the Southern District of Texas where available for ADR practice:Brownsville Corpus Christi Galveston Houston Laredo McAllen Victoria All (ADR proceedings will normally be conducted in the divisions in which the case is pending. Providers may not charge for travel from thedivision where they office to another division to conduct an ADR proceeding without prior approval of the parties.)Experience as ADR neutral: Number of cases mediated: arbitrated: summary/mini-trial judge: Other information: Do you commit to accept some cases for no fee or a reduced fee? Applicant Signature:Date:SDTX-ADR-1 12/17/2018 American LegalNet, Inc. www.FormsWorkFlow.com