David Hodges: Participant Information Form


Qualifications Civil Mediation Family Mediation Probate Mediation Arbitration Fee Schedule Scheduling Mediation Home Page		PARTICIPANT INFORMATION FORM (please print and fax to 254.772.9297) Style of Case: ___________________________ Court & Docket No. (If filed) ___________________________ County of filing __________________ Indicate: Mediation or Arbitration: Full or half day Date requested: _____________________________ PARTIES (1) Attorney’s (Adjustor’s) Name:___________________________ Firm: ________________________________________________ Address: ______________________________________________ City: ______________________ State: ____ Zip Code: _________ Phone: ________________________ Fax: __________________________ Email: _________________________ Party Represented: _______________________________________ (2) Attorney’s (Adjustor’s) Name:____________________________ Firm: _________________________________________________ Address: _______________________________________________ City: ______________________ State: ____ Zip Code: __________ Phone: _________________________ Fax: ___________________________ Email: __________________________ Party Represented: _______________________________________ (3) Attorney’s (Adjustor’s) Name:_____________________________ Firm: __________________________________________________ Address: ________________________________________________ City: ______________________ State: ____ Zip Code: ___________ Phone: __________________________ Fax: ____________________________ Email: ___________________________ Party Represented: ________________________________________ (4) Attorney’s (Adjustor’s) Name:_____________________________ Firm: __________________________________________________ Address: ________________________________________________ City: ______________________ State: ____ Zip Code: __________ Phone: _________________________ Fax: ___________________________ Email: __________________________ Party Represented: ________________________________________ (5) Attorney’s (Adjustor’s) Name:_____________________________ Firm: __________________________________________________ Address: ________________________________________________ City: ______________________ State: ____ Zip Code: ___________ Phone: __________________________ Fax: ____________________________ Email: ___________________________ Party Represented: ________________________________________
Office: 254.840.3291 Fax: 254.840.4261 Mob.: 254.744.1115 jdh@judgehodges.com

412 W. 3rd St. McGregor, Texas 76657