Membership Application
Prefix
Mr.
Mrs.
Ms.
First Name
*
Middle Name
*
Last Name
*
Name/Nickname you go by:
Birth Date (mm/dd/yyyy)
*
Email Address (personal)
Home Address
*
Home Number
Which address should we use for primary contact?*
Work
Home
Firm, Employer or Agency
*
Employer's website
Size of firm/organization
1-10 lawyers
11-30 lawyers
31-60 lawyers
61-100 lawyers
100+ lawyer
Position
*
Office Address
*
Office Number
*
Fax Number
*
Email Address (work)
*
Bar Status
*
I am an active member of the Virginia State Bar
I am not an active member of the Virginia State Bar.
I am currently a law student.
VA State Bar Number
Date Admitted (mm/dd/yyyy)
Legal Education
Referred by
I am not a member of the Virginia Bar; however, I am admitted to practice law in
Bar Number
Date Admitted (mm/dd/yyyy)
Name under which admitted (If different from above)
Membership (please Select one)
*
Application Fee for Active Practitioners ($125.00)
Law Student ($15.00)
Application Fee for Magistrate Judge ($0.00)
Area(s) of practice - Choose a Maximum of Five
Academic
Adoption
Alternative Dispute Resolution
Appeals
Banking & Finance
Bankruptcy
Civil Rights
Commercial Litigation
Communications
Constitutional Law
Contracts
Construction
Consumer
Corporate
Criminal
Retired
Education Law
Elder Law
Energy
Entertainment/Sports
Environmental
ERISA
Estate Planning/Trusts
Ethics/Professionalism
Family/Domestic Relations
Federal Litigation
General Practice
Government Service
Health Care
Housing
Immigration
Insurance
N/A
Intellectual Property
Juvenile
Legislative
Labor/Employment
Litigation/Trial
Practice Municipal/Local Government
Patent/Trademark/Copyright
Personal Injury/Negligence
Probate
Real Estate
Securities
Social Security
Tax
Transportation
Workers Compensation
Zoning
Other
Section Membership (check all that apply)
Bankruptcy Section ($25.00 dues)
Business Law Section ($30.00 dues)
Corporate Counsel Section ($25.00 dues)
Environmental & Energy Law Section ($25.00 dues)
Litigation Section ($25.00 dues)
Real Estate Section ($30.00 dues)