2017PANEL APPLICATION FORM

For New Members making application ONLY

Application must be received by February24, 2017

IDENTIFYING INFORMATION
(LRIS listings are by individual attorney, not law firm/affiliation)
Last Name: / First Name: / MI:
Firm Name: / Website:
Business Address: / Suite:
Business City: / State: / Zip:
Business Phone: / Fax: / Cell:
Email:

Provide a current copy of your resume.

On a separate page, state:

  1. Your law school and year of graduation.
  1. The year you were admitted to practice law in Minnesota.
  1. Your legal malpractice insurance carrier.

A copy of the declaration page of your malpractice insurance must be included with your application or be currently on file with LRIS.

  1. Describe your experience and/or substantive training related to commitment defense issues.

I understand that membership in the Hennepin County Bar Association (HCBA) and the Lawyer Referral and Information Service (LRIS) is a requirement of serving on the Commitment Defense Panel. I understand that any lapse in my membership in either organization, or any lapse of my malpractice insurance, will result in my suspension from the panel. I understand that the LRIS staff will monitor the expiration date of my insurance and require a copy of the new declaration page on renewal.

I am presently not under suspension or probation, either public or private, by the Minnesota Supreme Court. I authorize the Commitment Defense Project to verify my disciplinary status with the appropriate boards.

I understand that I will be suspended from the panel upon finding by an appropriate board that public discipline is warranted, or during any investigation of alleged misconduct.

I understand that appointments to the commitment defense attorney panel are made by an independent advisory panel. This appointment to the CDP Panel is for the period ending March 31, 2018. I understand that each year I must reapply for the panel, and that past membership on the panel does not guarantee reappointment.

If appointed, I will agree to serve as an advocate for my clients and will familiarize myself with alternatives to commitment and available resources.

I agree to the hourly compensation rate and will comply with the CDP billing procedures and policies. Except in unusual circumstances, any bill not submitted for payment within 60 days of the services rendered may not be paid. Any bill exceeding $770 will be separately justified in writing.

I will attend CDP meetings and seminars. I understand that panel members are expected to attend eightmonthly CDP meetingsduring 2017 - 2018, and attendance at education seminars will be taken into consideration for re-appointment to the panel.

By checking the following boxes, I am confirming that:

I am a member of the HCBA in good standing for the 2016-2017 year

I will maintain membership in the HCBA LRIS for the upcoming year

I will maintain malpractice coverage during my term on the Commitment Defense Panel

Signature : / Date:
MN Attorney Registration Number:

600 Nicollet Mall, Suite 390, Minneapolis, MN 55402

Phone: 612-752-6600 Fax: 612-752-6601