Book A Mediation - Karimjee Resolutions Inc.

1Booking Contact Person

2Plaintiff

3Defendant

4Mediation Details

5Confirmation

Step 1: Person Booking Mediation
Fill out the following fields for the person booking the mediation.
First Name
Last Name
Organization/Firm
Email
Phone
Address
Street Address Address Line 2 City Province Postal Code
Role in proceeding
- Lawyer Representing Party #1 / Plaintiff
- Lawyer Representing Party #2 / Defendant
- Self-represented Party #1 / Plaintiff
- Self-represented Party #2 / Defendant
- Other
Specify Role
Copy Assistant
- No
- Yes
Assistant
First Name
Last Name
Email

Party #1 / Plaintiff Information
Fill out the following fields for the Plaintiff.
Legal Representation
- Represented By Counsel
- Self-Represented
First Name
Last Name
Organization / Firm
Email
Phone
Address
Street Address Address Line 2 City Province Postal Code
Lawyer for Party #1 / Plaintiff
First Name
Last Name
Email
Phone
Organization/Firm
Address of Law Firm
Street Address Address Line 2 City Province Postal Code
Copy Co-Counsel
- No
- Yes
Co-Counsel
First Name
Last Name
Email

Party #2 / Defendant Information
Fill out the following fields for the Defendant.
Legal Representation
- Represented By Counsel
- Self-Represented
First Name
Last Name
Organization / Firm
Email
Phone
Address
Street Address Address Line 2 City Province Postal Code
Lawyer for Party #2 / Defendant
First Name
Last Name
Email
Phone
Organization / Firm
Address of Law Firm
Street Address Address Line 2 City Province Postal Code
Copy Co-Counsel
- No
- Yes
Co-Counsel Information
First Name
Last Name
Email
Additional Party Information
Fill out the following fields for if there are any additional parties.
Add Additional Parties?
- No
- Yes
Additional Parties
Name Role in Proceeding Lawyer's Name

Step 1: Person Booking Mediation

Name	Role in Proceeding	Lawyer's Name