LGBT Bar Association of the District of Columbia
NEW MEMBERSHIP & MEMBER RENEWAL FORM
COMPLETE THIS FORM OR RENEW ONLINE AT
Member Information
Name ______
Street Address ______Apt./Suite. No.______
City/State/Zip Code ______
Telephone Numbers with Area Codes: Home ( ) ______Work ( ) ______
E-Mail Address______
Law School Attended/Attending ______
Occupation: Attorney___ Law Student___ Law Professor___ Paralegal___ Legal Secretary___ Other______
Employer: Law Firm___ Government___ Public Interest Firm___ Corporation___ Sole Prac.___ Law School___ Other______
Name of Employer (Optional) ______State Bar Membership(s)______
Areas of Specialization:______
Attorney Referral Program: LGBT Bar Association of the District of Columbia sponsors an attorney referral service for which there is a separate application form and fee. Would you like to receive information about the program? Yes____ No____
Membership Directory: LGBT Bar Association of the District of Columbia maintains an online membership directory that is available to members. Do you authorize listing the above information in the membership directory?
Yes____ No_____ If yes, please sign your name______
LGBT Bar Association of the District of Columbia Committees and Activities
Please check the appropriate lines to indicate the committees or other activities of LGBT Bar Association of the District of Columbia in which you would like to become involved. A representative of the Board or the Committee will contact you:
Community Support & Involvement ____ Communications ____
Law Student Outreach and Mentoring ____ Membership ____
Professional Events and Education ____ D.C. Bar Candidates Survey & Forum ____
Attorney Referral Service ____ *Whitman-Walker Clinic Volunteer ____
*Some LGBT Bar Association of the District of Columbia attorneys volunteer once a month at Whitman-Walker Clinic to assist people with HIV/AIDS prepare simple planning documents (Wills,Medical Directives and Powers of Attorney). Training and mentoring are available.
Membership Dues
Basic membership dues vary according to annual income or student status. Sustaining Members receive a one-year LGBT Bar Association of the District of Columbia membership, one ticket to the Holiday Gala and, unless he or she chooses anonymity, listing as a Sponsor of the Holiday Gala in programs and promotional materials.
Please check the category that applies to you and write the amount in the space marked “Total Amount Due.”
Law Student………………………………………………………………………………………………………………………………….Free
Annual income less than $50,000 ...... $50.00/year
Annual Income between $50,000 and $100, 00……...... $75.00/year
Annual Income more than $100,000...... $100.00/year
Sustaining Member...... …………………………………………………………. $150.00/year
Sustaining Members: Check here___ if you do not wish to be listed as a Sponsor of the Holiday Gala.
Total Amount Due $______
Attach a check or money order payable to “LGBT Bar Association of the District of Columbia,” then mail the form and payment to:
LGBT Bar Association of the District of Columbia, P.O. Box 34072, Washington, DC 20043.
If you have questions, please email .