Name* (First, Middle Initial, Last)

Firm/Employer* Position/Title*

Work Address*

Home Address*

Telephone Number* Fax

Email*

Preferred Mailing Address:* Home Work

Publish in the Directory Address(es) from: Work Home Both

College* Year of Graduation* (yyyy)

Law School Year of Graduation (yyyy)

Grad School Year of Graduation (yyyy)

Honors

1 Not ApplicableAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandPuerto RicoSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

2 Not ApplicableAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandPuerto RicoSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

3 Not ApplicableAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandPuerto RicoSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

Would you like to be listed in the Referral Section of the CHBA Directory by area of practice?
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Which Setting best describes your office?

Attorney, Private Practice, Solo Practitioner
Attorney, Private Practice, Between 2-5 Attorneys
Attorney, Private Practice, Between 6-15 Attorneys
Attorney, Private Practice, Between 16-25 Attorneys
Attorney, Private Practice, Between 26-50 Attorneys
Attorney, Private Practice, Over 50 Attorneys
Attorney, Corporate Practice
Attorney, Federal Government
Attorney, State Government
Attorney, Municipal Government
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Judge, State
Judge, Probate or Other
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Yes

Would you be interested in serving as a mentor to a law student?

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IMPORTANT TAX INFORMATION
Dues to CHBA are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense. A portion of dues, however, is not deductible as an ordinary and necessary business expense to the extent that CHBA engages in lobbying.

Please check one:
Attorneys in practice ($50)
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