Request for Mediation

Please use this form to advise IMG about counsel, parties, and the case, in order for IMG to assist you in facilitating the opposition to mediation or other dispute resolution process.

This form can be completed by completing the fields below and may be submitted either online, or if you prefer, you may use the printable version which can be sent via fax or mail to the appropriate IMG office.

Dr. Barry Lotz
7825 Fay Avenue, Suite 200
La Jolla, CA 92038
858.456.1730 Fax

Request to Dr. Barry Lotz
Please communicate to all counsel, inviting him or her to take part in a conference call to discuss the processes indicated below. Please call me regarding this matter. Call me. (Available for non-binding processes, only.)

Fill in the sections concerning parties and representation or e-mail or fax a service list and case caption.

Information about your firm and client

Attorney(s) Firm Address
Party(ies) Name(s)
Information about other counsel and parties
See attachment for additional counsel and parties Information about the case

Type of case
Court/forum case name
Court/forum case number
Mediation cut off date
Status conference date
Trial date
Mediation cut off date

Process desired
Traditional Mediation Experts Mediation
International Mediation Baseball Mediation
Golf Mediation Football Mediation
Binding Mediation Binding High-Low Mediation
Mediation/Arbitration Arbitration/Mediation
Custom Design

Mail this form to: or fax this form to:

Dr. Barry Lotz
7825 Fay Avenue, Suite 200
La Jolla, CA 92038
858.456.1730 Fax

USA * Europe * Africa

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