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
*
Office Address
*
Office 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
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)
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)