Survey Form ABI ADR Newsletter

							         Survey Form ABI ADR Newsletter

         1.    Name _____________________________
         2.    Address ___________________________
         3.    E-mail address _________________________
         4.    Telephone ____________________________
         5.    Fax __________________________________
         6.    Check all that apply. I am:
               a. ___ a lawyer
               b. ___ arbitrator
               c. ___ mediator
               d. ___ judge (please specify what type of court)______________________
               e. ___ CPA
               f. ___ turnaround consultant
               g. ___ other professional
         7.    What topics would you like this newsletter to cover?_________
         _________________________________________________________
         _________________________________________________________
         _________________________________________________________
         _________________________________________________________

         8.     Please list topics of any articles you would like to write, and fill out contact info
                above:
        _________________________________________________________
        _________________________________________________________
        _________________________________________________________
        _________________________________________________________
        9.      Check all that apply:
                a. ___I would like to read about the law of ADR as it applies to bankruptcy and
        insolvency.
                b. ___ I would like to read about the law of ADR generally.
                c. ___ I want the newsletter to focus on mediation.
                d.___ I want the newsletter to focus on arbitration.
                e. ___ I want the newsletter to focus on both mediation and arbitration.
        10. I would like you to announce the following ADR-related news about me:
______________________________________________________________________________
______________________________________________________________________________
________________________________________________________
Please return this form to David Shaiken, Reid and Riege, P.C., One Financial Plaza, Hartford,
CT 06103. e-mail: dshaiken@reidandriege.com. Fax: 860-240-1002




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