Bench-Bar Coalition

Membership Roster Contact Form

Please add me to the Bench-Bar Coalition membership roster:

¨ Mr. ¨ Ms. ¨ Hon.

Name: _________________________________________________________________

Title/Position (e.g., Judge, President, Liaison): __________________________________

Bar Association Category: ¨ Local ¨ Minority ¨ Specialty ¨ Women’s

Bar Association: __________________________________________________________

Law Firm/Court/Agency: ___________________________________________________

Address: ________________________________________________________________

City and Zip Code: ________________________________________________________

Phone: Fax: _______________________

E-mail address:_______________________________________________________________________

If you would like to have your secretary or assistant copied on BBC e-mails, please fill in this section:

Secretary/Assistant’s Name: ______________________________________________________

Secretary/Assistant’s E-mail: ______________________________________________________

Please return this form by e-mail or fax to Jenniffer Herman:

or

Fax: 916-323-4347

Judicial Council of California, Governmental Affairs

770 L Street, Suite 1240, Sacramento, CA 95814

Telephone: 916-323-3121