SUPERIOR COURT OF WASHINGTON IN AND FOR THURSTON COUNTY No. , Plaintiff/Petitioner, vs. , Defendant/Respondent. NOTICE OF REQUEST TO PARTICIPATE IN ADR (CLERK'S ACTION REQUIRED - ADM 04) Plaintiff/Petitioner Defendant/Respondent requests participation in the following alternative dispute resolution process pursuant to Thurston County LCR 87. Mediation Peer-Attorney Settlement Conference The Names, Addresses and Telephone Numbers of ALL Counsel and parties in this action must be provided on the second page. The nature of this proceeding is (select only one): Motor Vehicle Injuries Other Torts Administrative Law Other Physical Injuries Real Property Dispute Contract Law Wrongful Termination Employment Discrimination Other:____________________ DATED this _____ day of ____________________, 2010. ____________________________________ Signed_________________________________ Print Name_____________________________ Attorney for:____________________________ Address:_______________________________ ______________________________________ Phone:________________________________ Request to Participate in ADR - 1 WASHINGTON STATE SUPERIOR COURT THURSTON COUNTY 2000 Lakeridge Drive SW Olympia, Washington 98502 (360) 786-5560 American LegalNet, Inc. www.FormsWorkFlow.com LIST NAME, ADDRESS & PHONE OF ALL OTHER ATTORNEYS OR PRO SE PARTIES Name: Attorney for: Address: Name: Attorney for: Address: Phone: E-mail: Phone: E-mail: Name: Attorney for: Address: Name: Attorney for: Address: Phone: E-mail: Phone: E-mail: Name: Attorney for: Address: Name: Attorney for: Address: Phone: E-mail: Phone: E-mail: Name: Attorney for: Address: Name: Attorney for: Address: Phone: E-mail: Phone: E-mail: WASHINGTON STATE SUPERIOR COURT THURSTON COUNTY 2000 Lakeridge Drive SW Olympia, Washington 98502 (360) 786-5560 American LegalNet, Inc. www.FormsWorkFlow.com Request to Participate in ADR - 2