Philly Barristers - Membership Application Your Name First Last HiddenYour Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your PhoneYour Email Your Date of Birth MM slash DD slash YYYY Who is this membership for? Myself Someone Else Member's Name First Last Member's Status Attorney Legal Professional Law Student Member's Company/Firm/Org Name Member's Company/Firm/Org Size Member's Job Title Member's Practice Area Member's Company/Firm/Org Website Address Member Law School / Professional Program Year Completed Law School First Year Admitted to Any Bar Awards and Distinctions Add RemovePlease use the plus icon to add to this listWould you like to volunteer as a Bar Exam Mentor to a graduating law student? (optional) Yes No Are you currently a member in good standing of the bar of any jurisdiction, or I am a legal professional or law student? Yes No Please indicate if you are interested in joining any of the following committees In-House Professional Committee Trial Lawyers of Color Professional Committee Non-Profit / Government Professional Committee MEMBERSHIP DUES * Law Students Legal Professionals / Legal Assistants Public Interest Attorney Attorney First Admitted During or After 2017 Attorney First Admitted During Or After 2017 (Two Year Membership) Attorney First Admitted Before 2017 Attorney First Admitted Before 2017 (Two-Year Membership) Please Sign to Authorize Us to Charge Your Credit Card I AUTHORIZE THE BARRISTERS’ ASSOCIATION OF PHILADELPHIA, INC. TO CHARGE MY CREDIT CARD ABOVE FOR AGREED UPON PURCHASES. I UNDERSTAND THAT MY INFORMATION WILL BE SAVED TO FILE FOR FUTURE TRANSACTIONS ON MY ACCOUNT.Checks made payable to The Barristers’ Association of Philadelphia, Inc. should be mailed to: THE BARRISTERS’ ASSOCIATION OF PHILADELPHIA, INC. 1735 MARKET STREET, SUITE A234 PHILADELPHIA, PA 19103
