Attorney Registration (Of Previous Bar Admission)

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT ATTORNEY REGISTRATION TO BE COMPLETED ONLY IF YOU WERE PREVIOUSLY ADMITTED TO THE FOURTH CIRCUIT BAR NAME (present practicing name) Last _____________________________________________________________________________________ First ____________________________________ Middle _________________________________________ Generation (Jr.,Sr.,II,etc.) ___________ Title (if applicable) _______________________________________ Prefix (Mr.,Ms.,Professor,etc.) ________________________________________________________________ FIRM: ___________________________________________________________________________________ ADDRESS: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ City ____________________________________________________________________________________ Zip Code ____________________________ Ext. __________ Fax (____)___________________________ State _________________________ Phone (____)___________________ E-mail____________________________________________________________________________________________ YEAR OF BIRTH: _______ APPROXIMATE DATE ADMITTED TO U.S. COURT OF APPEALS FOR THE FOURTH CIRCUIT __________________________________________________________________________________________ STATE OF RESIDENCE ____________________________________________________________________ IF ADMITTED UNDER A DIFFERENT NAME, PROVIDE NAME UNDER WHICH YOU WERE ADMITTED _______________________________________________________________________________ SCC 10/03/2011 American LegalNet, Inc. www.FormsWorkFlow.com