Fill and Sign the Of Each County in Which You Wish to Serve Form

APPLICATION FOR ADMISSION TO ROSTER OF CIVIL ARBITRATORS A separate form must be sent to the Arbitration Administrator of each County in which you wish to serve LAST NAME FIRST NAME MIDDLE NAME FIRM/BUSINESS FIRM/BUSINESS ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER Number of years of legal experience: Name of Group/Organization in which you served as an arbitrator: Bar Admission Year: New Jersey: Other States: Counties in which you appear and are willing to arbitrate: I have at least seven years’ experience in the following areas and request to arbitrate them (check all that apply): 502 Book Account 599 Contract – Other 610 Auto Neg - Prop 503 Commercial Transaction 602 Assault/Battery 506 PIP Coverage 603 Auto Neglect-Personal Injury 512 Lemon Law 605 Personal Injury I certify that the foregoing statements made by me are true and that I am in good standing in my profession. ______________________ _________________ Signature Date Return this form with a copy of your resume to: Arbitration Administrator of the County See Page 2 for Names and Addresses of Arbitration Administrators Revised 10/2007, CN 10507-English page 1 of 2 Atlantic County Arbitration Louise Pelosi Atlantic County Superior Court. 1201 Bacharach Boulevard Atlantic City, NJ 08401 609-345-6700 Ext. 3201 Bergen County Arbitration Christine Cordasco Bergen County Superior Court 10 Main Street, Suite 415 Hackensack, NJ 07601 201-527-2735 Burlington County Arbitration Patricia A. Spiehs Burlington County Superior Court 49 Rancocas Road P.O. Box 6555 Mt. Holly, NJ 08060 609-518-2816 Camden County Arbitration Stephen Gladden Camden County Hall of Justice Suite 150 101 South Fifth Street Camden, NJ 08103 856-379-2200 Ext. 3039 Cape May County Arbitration Arlette Y. Anderson Cape May County Superior Court 4 Moore Road, DN 203 Cape May Court House, NJ 08210 609-463-6515 Cumberland County Arbitration Kathleen Graham Cumberland County Courthouse Civil Division, Rooms 162-185 Broad and Fayette Streets Bridgeton, NJ 08302 856-453-5531 Essex County Arbitration Crystal Page Essex County Superior Court Hall of Records, Room 233 465 Dr. Martin Luther King, Jr. Blvd. Newark, NJ 07102 973-693-6447 Gloucester County Arbitration Rebecca Bertino Gloucester County Courthouse Civil Case Management P.O. Box 750 Woodbury, NJ 08096 856-853-3228 Hudson County Arbitration Cheryl D'Anna Hudson County Superior Court Civil Division - Arbitration 583 Newark Avenue Jersey City, NJ 07306 201-795-6372 Hunterdon/Somerset/Warren County Arbitration Ellen Reaves Somerset County Courthouse P. O. Box 3000 Somerville, NJ 08876 9 08-231-7000 Ext. 7659 Mercer County Arbitration Cindy Leslie-Post Mercer County Civil Case Management 175 South Broad Street P. O. Box 8068 Trenton, NJ 08650 6 09-571-4454 Middlesex County Arbitration Fee O’Brien Middlesex County Courthouse One John F. Kennedy Square P. O. Box 964 New Brunswick, N.J. 08903 7 32-981-3330 Monmouth County Arbitration Laura Larkin Civil Assignment Office Monmouth County Courthouse Monument and Court Streets Freehold, NJ 07728 732-677-4246 Morris/Sussex County Arbitration Elizabeth Erb Civil Division Manager’s Office P.O. Box 910 Morristown, NJ 07963-0910 973-656-4103 Ocean County Arbitration Kimberly Knapp Ocean County Courthouse 206 Courthouse Lane, 2 nd Floor Toms River, NJ 08754 732-929-4771 Passaic County Arbitration Joan Neubert Passaic County 77 Hamilton Street, 3 rd Floor Paterson, NJ 07505 973-247-8198 Salem County Arbitration Jeanne Evangelisti Salem County Courthouse Civil Case Management Office 92 Market Street P.O. Box 29 Salem, NJ 08079 856-935-7510 Ext. 8207 Union County Arbitration Doris Tarquinio Union County Superior Court Civil Arbitration Albender Building, 2 nd Floor 1143 East Jersey Street Elizabeth, NJ 07201 908-659-3625 Revised 10/2007, CN 10507-English page 2 of 2