Henning Mediation, Arbitration and Videoconference Scheduling

Henning Mediation & Arbitration Service, Inc.
Scheduling Request

I would like to schedule a: (check all that apply) Mediation Arbitration Videoconference Please complete the scheduling request below. A Henning Mediation & Arbitration Service, Inc. representative will contact you to confirm your request. Any information you provide will be used solely for the purpose of fulfilling your scheduling request. Please see our Privacy Policy for full details.
*Name
Title
Company/Firm
Address

City
State
Zip
Country
*Phone
Fax
*email

* required fields

You are the: Plaintiff Atty Defendant Atty Insurance Rep
Date of Loss:	(mm/dd/yyyy)
Style of Case:
Type of Case:
Who you represent:
Have all the other Parties agreed to have this case heard by HMA? Yes No
Is this case in suit? Yes No Court Pending:

Additional Parties:
	Plaintiff Atty Defendant Atty Insurance Rep
Name:
Phone:
email:
Company/Firm:

	Plaintiff Atty Defendant Atty Insurance Rep
Name:
Phone:
email:
Company/Firm:

	Plaintiff Atty Defendant Atty Insurance Rep
Name:
Phone:
email:
Company/Firm:
Additional Parties can be added during scheduling confirmation.

Preferred Dates/Times: (All times are U.S. EST)
1st Preference:	(mm/dd/yyyy) Time:
2nd Preference:	(mm/dd/yyyy) Time:
3rd Preference:	(mm/dd/yyyy) Time:

Preferred Neutral: Please click here to Find A Neutral.
1st Preference:	View List of Neutrals
2nd Preference:	View List of Neutrals
3rd Preference:	View List of Neutrals

For Videoconferencing Only: (Please specify city & state, zip code or country)
Local Site :	Number of Persons
Remote Site 1:	Number of Persons
Remote Site 2:	Number of Persons
Remote Site 3:	Number of Persons
Number of hours:

Additional Comments : Please add any comments pertinent to your case.