Participate in an Arbitration Claim

You can list up to 4 representatives on ths form. If there are more than 4, please complete another form.

Claim Number*

Party(ies) You are Representing*

Status*

Select

1st Representative's Name*

Role (1)*

Select or enter value

Email Address (1)

Phone Number (1)

I already have login credentials*

Say yes if you already have an account in the AHLA Case Management system. This is different from the AHLA Member database.

Select

2nd Representative's Name

Role (2)

Select or enter value

Email Address (2)

Phone Number (2)

I already have login credentials (2)

Say yes if you already have an account in the AHLA Case Management system. This is different from the AHLA Member database.

Select

3rd Representative's Name

Role (3)

Select

Email Address (3)

Phone Number (3)

I already have login credentials (3)

Say yes if you already have an account in the AHLA Case Management system. This is different from the AHLA Member database.

Select

4th Representative's Name

Role (4)

Select

Email Address (4)

Phone Number (4)

I already have login credentials (4)

Say yes if you already have an account in the AHLA Case Management system. This is different from the AHLA Member database.

Select

Send me a copy of my responses