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Vermont Bar Association - Lawyer Referral Service Application Form - Vermont
| Vermont Bar Association - Lawyer Referral Service Application Form Form. This is a Vermont form and can be used in Miscellaneous Statewide . |
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Vermont Bar Association Lawyer Referral Service Application Form First Name Middle Initial Last Name Firm/Organization Address City State ZIP Code - Phone # (000-000-0000) Fax # (000-000-0000) E-Mail Address LOCATIONS: Addison Chittenden Lamoille Orleans Windham Bennington Franklin New Hampshire Rutland Windsor Caledonia Grand Isle Orange Washington Adoptions Domestic Landlord/Tenant Public Health Arbitration Education Law Landlord Only Real Estate Arts Law Elder Law Legal Malpractice Securities Banking Law Employment Mediation Social Security Disability Bankruptcy Entertainment Mediation Domestic SSI Business Environmental Medicaid Taxation Civil Rights Foreclosures Medical Malpractice Tort & Negligence Collection Guardianship Mental Health Trademarks Construction Law Immigration Military Traffic Consumer Complaints Intellectual Property Municipal Law Wills, Trusts, Estates Contracts International Law Non-Profit Workers Compensation Copyrights Juvenile Patents Zoning Criminal Labor Relations Professional Licensing Other Licensed in another State(s): PLEASE ATTACH COPY OF DECLARATIONS PAGE FROM YOUR PROFESSIONAL LIABILITY POLICY I carry Professional Liability insurance in the amount of $ Name of Insurance Company I agree to hold the Vermont Bar Association harmless from clai bmy Vs ermont Bar Association Lawyer Referral Service Clients reerredf to me. Ihereby certify competency in any area of law in which I am seeking referrals, subject to Canon 6 and DR 6-101 of the Codofee ssoionaf PrlResponsibility. Date (00/00/00) Signature Individual Attorney - $60.00 Law Firm (5 lawyers or more) - $300.00 PAYMENT METHOD: Check enclosed (made payable to Vermont Bar Association) Credit Card Choose one: Credit Card # - - - Exp. Date Month: Year: Cardholder Signature PLEASE PRINT COMPLETED FORM & MAIL WITH PAYMENT & DECLARATIONS PAGE TO: VERMONT BAR ASSOCIATION, PO BOX 100, MONTPELIER VT 05601-0100
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