/ 2018 Membership Application
Date of Application:
PERSONAL INFORMATION
 Mr.
 Mrs.
 Ms.
 Judge
 Prof. / First Name / Middle Name / Initial / Last Name
 Mark here if you have had a name change since last year
Firm / Office Name / IN State Bar No. / Year(s) Admitted to Bar & State(s) of Admission:
Preferred Mailing Address
 Mark here if you have had an address change since last year / E-Mail Address  I prefer to receive all information via e-mail
Phone No.(s)
Fax No.
Demographic Information:
Gender:  Female  Male
Race/Ethnicity:  African American  American Indian  Asian  Caucasian  Hispanic  Multicultural
 Pacific Islander  Other  Decline to State / Practice Profile:
 Non-Profit Law Firm with:
 Government 1-9 Attorneys
 In-House  10-24 Attorneys
 Judiciary  25-79 Attorneys
 80+ Attorneys
EDUCATION & SKILL AREAS
Law School / Degree / Year / Undergraduate or Other Degree(s)/ Year(s) / Special Language Skills

Area(s) of Specialty

/ I am interested in joining the following MCBA Committee(s):
 Academia
 Administrative Law
 Antitrust & Trade Reg.
 Appellate Advocacy
 Alternative Dispute Resolution
 Banking & Finance
 Bankruptcy
 Business & Commercial Law
 Civil Rights
 Consumer Law
 Construction
 Criminal (Defense)
 Criminal (Prosecution)
 Customs & Int’l Trade
 Entertainment Law
 Environmental Law /  ERISA
 Estate Planning/Probate/
Trusts & Wills
 Family Law
 General Practice
 Health Care Law
 Immigration
 Insurance
 Intellectual Property
 Judiciary
 Labor & Employment
 Landlord-Tenant
 Legislative
 LBGT Issues /  Civil/Business Litigation
 Mergers & Acquisitions
 Military
 Municipal Law
 Personal Injury/Medical/Tort
 Poverty Law/Public Benefits
 Product Liability
 Professional Discipline/Ethics
 Public Interest
 Real Estate
 Securities
 Taxation
 Worker’s Compensation
 Zoning and Use
 Other ______/  Pro Bono
 Community Outreach
 Professional Development/CLE
 Issue and Advocacy
 Fundraising
I am interested in becoming involved with the following MCBA program(s):
 Pro Bono Case Work
 Holiday Fundraiser and Judicial Recognition Event
 Going to Church Program
 Shortridge Partnership
Kuykendall-Conn Dinner
Other ______
Dues (please mark one)
Lifetime
Fee - $1500
 Subscribing -
($500/yr for 3yrs)
 Renewing - Free
 Sustaining -
$200 (regular membership,
with donation) / Regular Membership:
Admitted 10+ years -- $150
Admitted 4-9 years -- $100
Admitted 1-3 years -- $50
Admitted less than 1 year -- FREE
Judiciary – 150.00
 Inactive / Retired Attorneys -- $50
 Associate Member -
(paralegals, legal secretaries, law grads) -- $25
 Law Students -- FREE / Mail application with a check payable to “Marion County Bar Association” to:
Marion County Bar Association
133 W. Market Street, #245
Indianapolis, Indiana 46204
E-mail:
MCBA Directory: Unless you indicate otherwise, the information provided above will be included in the online MCBA Directory available to all MCBA members.