Lawyer Registration Form


*First Name:
Required: Please enter your first name
*Last Name:
Required: Please enter your last name
*Law Firm/Company:
Required: Please enter your Firm/Company
*Address
Required: Please enter your address
*City
Required: Please enter your city
*State
Required: Please enter your State
*Zip
Required: Please enter your zip code
*County
Required: Please enter your county
*Email:
Required: Please enter your email address
       I am willing to work outside of this county.
*Primary Phone:
Required: Please enter a phone number
Work Cell Phone Other  
 Secondary Phone: Work Cell Phone Other  
*Supreme Court #
Required: Please enter your Supreme Court #
*Law School
Required: Please enter the law school you attended
*Area of Expertise
Required: Please enter your Area Expertise
* Attorney In Good Standing  Yes  No
Required: Please enter if you are in good standing
*Hours Available
Required: Please enter hours available
* Malpractice Insurance is Current  Yes  No
Required: Please enter malpractice insurance status
 
 I am willing to help in administrative and/or program development ways.
 
* indicates a field is required