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Issues to be mediated (in dispute concerning {{{1}}})

The parties should list the issue or issues over which there is dispute. Please sign each issue.

{{{2}}}

Comments (about request concerning {{{1}}})

Parties' agreement to mediation (of dispute concerning {{{1}}})

Each party is asked to add "Agree" or "Disagree" in this section, with their signature.

Agree. ~

Decision of the Mediation Committee (in request concerning {{{1}}})

Only members of the Mediation Committee should edit this section.

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