BOOK A DATE FOR MEDIATION Date Requested * MM DD YYYY Full or Half Day * Full Day In Person Full Day Zoom Half Day in Person Half Day Zoom Style of case/Names of parties involved * Requesting Lawyer Name * Requesting lawyer represents that all involved parties have agreed to mediate with Judge Jeff Rose on the date being requested. First Name Last Name Requesting Lawyer Email * Requesting Lawyer Phone * (###) ### #### Opposing Lawyer * First Name Last Name Opposing Lawyer Email Opposing Lawyer Phone * (###) ### #### Thank you!