Intellectual Property Arbitration Consent Form

Case/Reference Number

Disputing Parties

Party 1 Name

Party 2 Name

Summary of Intellectual Property Dispute

Consent to Arbitration

We, the undersigned, voluntarily consent to submit the above-described intellectual property dispute to arbitration in accordance with the applicable arbitration rules and procedures. We acknowledge and agree to be bound by the final arbitral decision.

Party 1 Signature

Date

Party 2 Signature

Date

Arbitrator (if selected)