Member Information
Name:_________________________________________________________________________________
Preferred name for nametag: ______________________________________________________________________________________________
Firm/Court/Organization: _________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
City:_________________________________________ State:___________ Zip:________
Phone: _________________________________________________ Fax:__________________________
Email: __________________________________________________________________________________________________
Title/Position: Judge Attorney Legal Educator Other____________________________
Primary area(s) of practice:_________________________________________________________________________________
Bar # _______________ Bar State: _____________________ Admittance Date: ___________________
Assistant’s Name: ________________________________________ Assistant’s Phone:_________________________
Assistant’s E-mail:____________________________________________________
Membership Intention
____ I will renew my membership for the next Inn year
_____I will not renew my membership for the next Inn year
Member Interests
I am willing to serve in the following areas of Inn management:
_____ Leadership/Mentoring _____ Finance & Budget _____ Law School Liason
_____ Court Liason _____ CLE _____ Programs
_____ Social _____ Membership _____ Any of the above
Benchers Only: Are you willing to lead a pupillage group? Yes / No
Please provide suggestions for improving our Inn: __________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Inn use only: Associate. Barrister Bencher