Case #            _____________________________________________________________________

Case Name:    _____________________________________________________________________

The undersigned parties agree to submit the above-referenced matter to binding arbitration and agree that Sarah E. Worley shall serve as the arbitrator. In so doing, the undersigned acknowledge that the Arbitration Rules of Sarah E. Worley Conflict Resolution, P.C. shall govern all matters related to this arbitration and are incorporated herein by reference.

The parties further agree that:

1. The fee for the arbitration of this matter is $              per party.  That fee shall be paid in full to Sarah E. Worley Conflict Resolution P.C. before any arbitration decision is released to the parties.
2. The admissibility of evidence and the weight given to any particular evidence shall be within the sole discretion of the arbitrator.
3. Neither Sarah E. Worley nor Sarah. E. Worley Conflict Resolution P.C. shall be liable to the undersigned for any act or omission in connection with the arbitration of this matter, or in connection with the decision rendered in this matter.
4. The arbitrator’s work product, including notes, case files and any other materials pertaining to the arbitration are confidential and shall not be subject to disclosure in any legal or administrative matter or setting.