Last Name: ________________________

First Name: ________________________ MI: _____________

Bar Exam Passed: _____ February _____ July

Date of Admission to the PA Supreme Court: ____/____/____ Supreme Court I.D. Number: _____________

Have you ever been a member of the Pennsylvania Bar Association? ____ Yes (see below) ____ No

If Yes, Earliest Date Admitted _____/_____/_____

Admission to other states and dates admitted:

State: _____________________  Date Admitted: ___/____/____

State: _____________________  Date Admitted: ___/____/____

State: _____________________  Date Admitted: ___/____/____

Firm Information:

 

Type of Practice (Check One): ____ Firm ____ Sole Proprietor ____ Corporate ____ Government

Law Firm Name (If Any): _____________________________________

 

Email: ________________________

 

Address: ______________________________

City: _________________ State: _____ Zip Code: _________

Describe your type of practice: _______________________________________________________________

Phone Number: (____)_____-______

Fax Number: (____)_____-______

Direct Line: (____)_____-______

Mobile Line: (____)_____-______

Personal Information:

Home Address: _________________________

City: _________________ State: _____ Zip Code: _________

 

Home Phone Number: (____)_____-______

Fax Number: (____)_____-______

 

Date of Birth: _____/_____/_____

Spouse Name: ____________________________

 

Preferred Mailing Address (Home/Firm): ____________

School Information (Name of School, Graduation Date):

College: __________________________________________ _____/_____/_____

Law School: __________________________________________ _____/_____/_____

Sponsor Name: ___________________________________________________________________________

Sponsor Firm: ____________________________________________________________________________

Sponsor Address: __________________________________________________________________________

Sponsor Signature: ______________________________________________________________________________

I hereby apply for membership in the York County Bar Association. I acknowledge and understand that in order to complete my membership in the Bar Association, I must pay any applicable fees. I also must attend the orientation program presented by the Bar Association or view the orientation video at the Bar Center, if I qualify for the Young Lawyer Section. Presentation to the bench of the York County Court of Common Pleas occurs in December.

Mentor Information (For Completion By Bar Association Staff):

Mentor Named by Bar Association: ___________________________________________________________

Mentor Assigned by: _______________________________________________________________________

Date Mentor Assigned: _____/_____/_____