COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. UNITED STATES DISTRICT COURT No. : Calendar FOR THE : JUDICIAL SUBPOENA Plaintiff(s) DISTRICT OF WYOMING -against- : : APPLICATION FOR MEMBERSHIP ON PANEL OF NEUTRALS : Application is made for membership on the neutral panel with the United States District Court for the District of Wyoming as provided for by the Local Court Rules. Defendant(s) : ...................................................... Name:______________________________________________________________________________ Firm Name:__________________________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK Office Address:____________________________________________Tel. No.____________________ TO ____________________________________________________________________________________ (City) (State) (Zip) GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court ATTORNEY NEUTRALS located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 1. or adjourned date, to testify and give evidenceBar: witness in this action on the part of the Date admitted to the Wyoming State as a ______________________ WBA No._____________ 2. 3. Are you a member in good standing of the Wyoming State Bar? ______Yes _____ No Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Have you ever been a party to any legal proceedings, civil or criminal, charging you with moral turpitude or commission of a crime; or been disbarred, suspended from practice or otherwise Witness, Honorable , one of the Justices of the disciplined by any court or administrative body; or have any proceedings been instituted against Court in County, day of , 20 you in any court, administrative body, bar association or grievance committee; or have you ever been refused admission to any Bar of Court? (Attorney must sign above _____ Yes _____ No If yes, please attach an affidavit of explanation. and type name below) 4. Attorney(s) for Date admitted before the bar of the United States District Court for the District of Wyoming: ______________________________________________________________________________ 5. Office and P.O. Address Other Court/Bar Professional Associations:___________________________________________ ______________________________________________________________________________ Telephone No.: Facsimile No.: ______________________________________________________________________________ E-Mail Address: Mobile Tel. No.: ______________________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index the 6. Check the areas of legal practice or experience which best describes No. majority of your legal practice and indicate the number of years of experience in each: : “ Admin Law ____ years “ Antitrust ____ years “ Asbestos ____ years -against“ Banking ____ years “ Bankruptcy ____ years “ Business/Commercial Calendar No. “ Criminal ____ years : “ Medical Malpractice Plaintiff(s) “ Civil Rights ____ years JUDICIAL SUBPOENA “ Employment ____ years ____years : Areas_______________ “ Oil & Gas ____ years “ § 1983 ____ years : “ Patent/Trademark/ Copyright ____ years “ Debtor/Creditor ____ years Speciality:_____________ “ Environmental Law : “ Personal Injury ____ Defendant(s) ____ years “ Computer Law : . . . . . . . . . . . . . . . . . . . . . . ____. years. . years . . . . . . . . . . . . . . . . .... .... ..... “ Contracts ____ years “ Insurance ____ years “ Construction ____ years “ Labor ____ years THE PEOPLE OF THE STATE OF NEW YORK TO ____ years “ Products Liability ____ years “ Securities ____ years “ Other, specify: ______________________________________________; _____ years GREETINGS: APPLICANT SHALL PROVIDE A COMPREHENSIVE WRITTEN THE DESCRIPTION OF HIS/HER LEGAL PRACTICE AND EXPERTISE IN EACH WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before AREA CHECKED. , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed ADR TRAINING COMPLETED or adjourned date, to testify and give evidence as a witness in this action on the part of the 7. a. Hours of ADR training completed_______________________________________ b. Date(s) of training, course provider and course content______________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to _____________________________________________________________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a _____________________________________________________________________ result of your failure to comply. c. Have you ever been observed by another trained neutral (not during training)? ______ Yes ______ No; When________________; Where_____________________ Witness, Honorable , one of the Justices of the Explain______________________________________________________________ Court in County, day of , 20 ADR EXPERIENCE (Attorney must sign above and type name below) 7. Number of ADR Proceedings held to date_________ Describe________________ ____________________________________________________________________ Attorney(s) for 8. References (ADR Experience)____________________________________________ 9. References (Other)_____________________________________________________ Office and P.O. Address FEES 10. Telephone No.: Describe and list the reasonable fees that you will charge the parties for your services Facsimile No.: to conduct ADR: E-Mail Address: ____________________________________________________________________ Mobile Tel. No.: _____________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 11. Index No. Are you willing to accept cases for mediation for a reduced fee or pro bono? : Calendar No. ______ Yes ______ No : Plaintiff(s) -against- JUDICIAL SUBPOENA : I certify that the foregoing is true and correct. : ____________________________ Date _______________________________________ : Applicant Defendant(s) : ...................................................... RETURN COMPLETED APPLICATION TO: THE PEOPLE OF THE STATE OF NEW YORK TO United States District Court Attention: Deb Birge, ADR Administrator P.O. Box 268 Cheyenne, WY 82003 GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com