Membership App.

Membership Application
Please complete this application and submit.

*indicates required fields

*Name:

*Home Phone:

*Office Phone:

*Email Address:

*Office Address:

*Home Address:

*Date of Admission to Practice Law:

*Attorney No.:

*Courts you are admitted to practice law:

US Supreme Court
Indiana Supreme Court
Northern District Indiana
Southern District Indiana
Others

If Other:

*High School:

*Graduation Date:

*Degree & Honors:

*Undergraduate:

*Graduation Date:

*Degree & Honors:

*Law School:

*Graduation Date:

*Degree & Honors:

*Other:

*Date of Birth:

*Place of Birth:

*Marital Status:

*Name of Spouse:

*Children (Name & Ages):

*Community Activities:

*Other Civic or Professional Organization:

*Positions Held in those organizations:

*Have you ever been disbarred:

yes
no

*Any other disciplinary committee action:

yes
no

*Been expelled or suspended from any instiution:

yes
yes

*Have you been charged or convicted of any crime:

yes
no

If you answered yes to any of these explain:

*List to references other relatives or partners:

*I affirm the above information is true:

true
false

After filling in the details and submitting online please send your check for $40 for the current dues. Make check payable to the “Hendricks County Bar Association” attention Treasurer, Hendricks County Bar Association Sally S. Steward, Howard & Lawson, 111 S. Washington Street, Danville, IN 46122

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