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You can type the information directly into this form. When complete, please print, sign and date it, and then mail to:
ADR Center
57 North Street, Suite 214
Danbury, CT 06810

Labor Dispute Resolution Submission Form
Please complete the following:
Date:

Union Employer
Name of Party 1
Address
City, State & Zip Code
Telephone                                 Fax
Name of Attorney or Representative
Name of Firm or Company
Street Address
City State & Zip Code
Telephone                                 Fax
Signature of Party or Representative
Union Employer
Name of Party 2
Address
City, State & Zip Code
Telephone                                 Fax
Name of Attorney or Representative
Name of Firm or Company
Street Address
City State & Zip Code
Telephone                                 Fax
Signature of Party or Representative

The parties named above agree to submit this dispute to the American Dispute Resolution Center, Inc (ADR Center).

Procedure Agreed Upon:
Arbitration Mediation Other
Rules Agreed Upon:
ADR Center Other
Name of Grievant:
Nature of Dispute:
Relief Sought:
Location of Hearing:
By signing the above, the parties hereto agree to abide by any arbitration award rendered in this matter.

ADR Center • 57 North Street, Suite 214 Danbury, CT 06810
Phone (860) 832-8060 • www.adrcenter.net