Complete the information required.
First Name
M.I.
Last Name
Firm Name
Address
City
State
Zip
Phone
Ext.
Mobile
Fax
E-Mail
Website
Year of Admission to New York Bar and Department:
Other Admissions:
Other Bar Associations:
Type of Practice (Check as applicable)
Legal Aid
18-B/CJA Panel
Private Practice - Solo/Small Firm
Private Practice - Large Firm
State Criminal Practice
Federal Criminal Practice
Judge
Alternate Provider/Defender
White Collar Defense
Select Type of Practice
Membership Type
Regular
Public/Alternate Defender
New Lawyer
Judge
Associate
Honorary
Select Type of Membership
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