North Dakota Statewide ADR Neutral Roster

Alternative Dispute Resolution
North Dakota State Court AdministratorADR - Neutrals Roster

Name: _________________________________________

Address: _________________________________________

City:_________________________State:_________ Zip: ________

Telephone: _________________________________________

Fax: __________________________________________

Email: __________________________________________

Rosters: (please check)

□ Civil Arbitration □ Civil Mediation □ Domestic Relations/Contested;Child proceedings Mediation

I attended the following alternative dispute resolution continuing education course/conference:
(Please use reverse side or attach a separate sheet to report more than one course and include a copy of your training certificate.)

Title: ______________________________

Sponsor: ______________________________

Location: ______________________________

Dates(s): _______________________ ______

Hours of actual education: ___________________________________________

Please list your speciality areas: _________________________________________________

I do hereby certify that the information provided is true and that I meet the qualifications required in North Dakota Rules of Court Rules 8.8 and 8.9.

Signature: _________________________________
Date: ___________________

Return form along with resume and photocopy of training certificate(s) to Marilyn Moe, State Court Administrators Office, 600 E Boulevard, Dept 180, Bismarck, ND 58505-0530