Form NMB-9 Application for Alternative Dispute Resolution (ADR) Ser

Mail:

ADR Services Fax: ADR Services 202-692-5084

National Mediation Board

Suite 250E Email: [email protected]

1301 K Street, NW

Washington, DC 20005 Phone: 202.692.5030

Form NMB-9 OMB No. 3140-0009 Expiration Date 01/31/2013

Application for ADR Services

PARTIES REQUESTING SERVICE:

Carrier Name		Organization Name
L. R. Official/Title		Organization Official/Title
Address		Address
City, State & Zip Code		City, State & Zip Code
Telephone		Telephone
Fax		Fax
Email		Email
Signature of Carrier Official/ Representative		Signature of Organization Official/ Representative
Date		Date

1. Fully complete the above information for your company/organization and also the name, phone number, and company/organization of the other party.

2. The NMB requires an application from each party with a signature before services are scheduled.

3. Select the type of ADR service(s) below by placing a  in the appropriate box.

TYPE OF ADR SERVICE REQUESTED:

	Facilitation Services
	Grievance Mediation Services
	Grievance Mediation Training
	Interest Based Bargaining (IBB) Training
	On-Line Dispute Resolution (ODR) Training
	Preparation for Mediation Training
	Other: (describe)

Class or Craft:	Number of Employees:
Number of Participants (Training Only):

Instructions:

1. ADR services are voluntary; both parties must be interested in participating before services are scheduled.

2. Complete application in full.

3. Fax, E-mail, or Mail to ADR Services. (See e-mail address, fax number and mailing address above.)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is 3140-0002. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

Revised September 2009