Contra Costa County Bar Association Fee Arbitration Program
 Waiver of Personal Appearance

_____________________________________________
Client Name

_____________________________________________
Attorney Name

I, ___________________________________________, am the [    ] client / [    ] attorney in this matter.  I will be unable to attend the hearing and I waive my personal appearance.

My written testimony and/or exhibits are:

[    ]  Attached to this document

[    ]  Included with the Client's Request for Arbitration

[    ]  Included with the Attorney's Reply

In addition,
[    ]  I do not designate a representative to attend the hearing for me.

[    ] do designate* a representative to attend the hearing for me.

_______________________________________________
Name*

_______________________________________________
Address*

_______________________________________________
City, State, Zip*

_______________________________________________
Daytime area code and telephone number*

I declare under penalty of perjury under the laws of the State of California that any statements in this waiver form and exhibits attached to this document are true and correct.

______________________________________________
Signature

______________________________________________
Date