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Fill and Sign the Agreement to Mediate New Hampshire Judicial Branch Form

Fill and Sign the Agreement to Mediate New Hampshire Judicial Branch Form

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NHJ B-2052-F (12/ 07/ 2006) Page 1 o f 1 THE ST A TE O F NEW H A M PSHIRE JUDI CI AL BR AN C H Cour t N ame: Ca se Nam e: Ca se Num ber: (if k now n) M EDI ATI O N P AR TICI PATI ON AG REEM ENT 1. Medi ati on is a pr ivate pr ocess w her e w e w ill w ork to ex plor e opti ons for resol ving the matt er that br oug ht us h ere today . 2. The medi ator is an impartial per so n w hose j ob i s to hel p us r each an ag reem ent th at i s fai r to all, w ithout m aking th e deci sions for us. 3. The m ediator w ill n ot pro vide m arita l cou nseling o r le ga l a dvice . 4. W e may seek l egal ad vice f rom an att orney of our ow n ch oosi ng at any time. W e ar e enco uraged t o have an attor ney review the final ag reem ent be for e w e si gn it. 5. W e w ill h onestly d isclose a ll info rm ation essen tial to b ringin g th is ma tte r t o an a gre em en t. 6. Ev ery thing sai d or w ritten d uring the me diati on i s con fiden tial, ex cep t as pr ov ided by N ew Hamps hire l aw or cour t r ules. 7. W e w ill no t sub poena the m edi ator or his/ her records a bout any thing said or ag reed u pon dur ing the me diati on. 8. The medi ator is paid for hi s/her ser vices at $6 0 an ho ur as fol lows (please c heck a nd i nitial the appr opr iate l etter choi ce) : A. w ill pay the en tire fee. B. The fee w ill be prop ortionally shared w ith pay ing % an d pay ing %. a. Prov ided w e financially qualif y, th e fee w ill be paid by the St ate of N ew Ha m pshire in itia lly . W e w ill a rra nge with th e State of Ne w Ha m psh ire Off ice of C ost C ont ainm en t to pay back our respecti ve shar e o f th e total fee. b. Other: Date Pet itioner Attor ney for Pet itioner Date Res pon dent Attor ney for Res pon dent Date Med iator

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