Jefferson County Bar Association Membership Application 2005-06

JEFFERSONJEFFERSON COUNTYCOUNTY BARBAR ASSOCIATIONASSOCIATION MEMBERSHIPMEMBERSHIP APPLICATIONAPPLICATION 2012-20132012-2013 1001 Pearl, Ste. 202 ▪ Beaumont, TX 77701 ▪ 409-835-8647▪ 409-835-8778 FAX ▪ www.jcba.org ▪ [email protected]

Every membership request/renewal must provide an application. If you are over 70 and exempt from Bar dues, please complete & return the application. NAME & ADDRESS (please print)

Name______

Firm ______Email Address______

Work Address______City ______State ______Zip ______

Phone ( ) ______Fax ( ) ______Bar Card # ______DOB _____ / _____ / ______

Home Address ______City______State______Zip______

Home Phone ( )______Spouse ______Website Address______

Cell Phone (optional) ______Male □ Female □ Please tell us how you would like to be contacted □ Email □ Fax

How would you like to receive the Jefferson County Bar Journal publication? □ Printed publication via Mail □ PDF file via email?

PRACTICE SETTING

Judge □ Federal □ State □ Probate Attor ney □ Private Practice □ Government Position □ Corporate □ Partner, Shareholder or Associate in law practice □ Professor □ Retired □ Law Office Staff Other □ Non-law related □ Law Student □ Other ______

CATEGORY SETTING

In which area/s of law do you primarily practice? ______In which area/s are you Board Certified? ______

Other state(s) licensed to practice ______Language(s) spoken ______

MEMBERSHIP CATEGORY Please check appropriate category □ JCBA Membership $ 100.00 ______□ JCBA Senior Membership (70 yrs or over) $ N/A ______□ JCYLA Membership* (in practice less than 5 years and/or 36 years of age or younger) $ 75.00 ______* All JCYLA Attorneys are granted JCBA membership automatically SECTION MEMBERSHIP *must be a JCBA/JCYLA member to join any section □ Family Law Section $ 30.00 ______□ Criminal Defense Section $ 30.00 ______

Total Amount Due $ ______SUBMITTING PAYMENT Please make checks payable to the Jefferson County Bar Association Retur n application and payment to 1001 Pearl Street, Ste. 202 / Beaumont, Texas 77701 Thank you for your suppor t! Office Use Only Amt$ ______Cash□ Check# ______CC/WS □ Received ______Renewal □ New Member □ Database □ Website □ Initials ______