Confirmation of Settlement Authority

Case Name: _____________________________________________

Return by: _____________________________________________

The most important thing we need to confirm in advance of the mediation is the attendance of the person or persons who have the final settlement authority in this case.

Please transmit this form back to us by the return date above.

The undersigned represents to the mediator that the following person(s) will personally attend the mediation session and will have the final authority to settle this matter on behalf of my client with no limitation as to the terms of settlement. This person(s) has the ability to change settlement position based on unfolding events during the mediation day and does not have to call outside of the room for settlement authority.

Name                                  Title                                                                Telephone

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

If for any reason there is any question or limitation as to the authority of the person(s) attending the mediation, please contact our office immediately so that a decision may be made as to whether the mediation should go forward.

Date: _____________

Signed: _____________________________________________

Attorney for: __________________________________________

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> Confirmation of Settlement Authority