Mandatory Advertising Filing Form Pursuant To RPC 7.2A

For Administrator Use Only: STATE BAR OF NEVADA MANDATORY ADVERTISING FILING FORM PURSUANT TO RPC 7.2A (Current as of 12/13/12) Effective September 1, 2007, Rule of Professional Conduct ("RPC") 7.2A (Advertising Filing Requirements) requires that a lawyer file with the state bar a copy or recording of an advertisement or written or recorded communication within 15 days of first dissemination along with a form supplied by the State Bar, except those advertisements exempt pursuant to Advertising Committee Rule ("ACR") 2(o). If desired, advance opinion may be obtained pursuant to RPC 7.2(B) by submitting a copy of the advertisement with an application form and the fee required by ACR 8. If an advance opinion is requested, the committee shall issue a written opinion within 30 days of submission. Ad. #: __________________ Date Rec'd _____________ District_________________ Type of Ad______________ Ackn. Letter Sent_________ Fwd. to Committee________ Next Action:_____________ 1. 2. 3. Complete Filing Form in full. Please print or type. Application may be reproduced. A separate Filing Form must be submitted for each advertisement or writing. Attached advertisement or writing. Ø Each form regarding a written, recorded or other electronic media advertisement or solicitation shall be accompanied by a copy of the advertisement or solicitation. Ø An audio or video advertisement shall be accompanied by a recording of the advertisement and a written transcript of the recording. Ø Any public media advertisement or solicitation communication in a non-English language shall be accompanied by a complete, accurate English translation in addition to the copy of the script in the same language of which the advertisement is recorded in. Ø Audio and video recordings shall be submitted in DVD, CD or e-mail format. INSTRUCTIONS FOR SUBMISSION OF THE APPLICATION 4. This form and its attachments may be submitted in either physical or digital format to: Attn.: Luisa Cota Advertising Administrator State Bar of Nevada 600 East Charleston Blvd. Las Vegas, NV 89104 EMAIL: Luisac@nvbar.org A separate filing form must be submitted for each advertisement or writing and only one (1) copy of the advertisement is necessary. For questions concerning filing requirements visit www.nvbar.org, Advertising Section or call 702-382-2200, Ext. 418. Lawyer: ____________________________________________________ Bar No. ________________ Firm: _______________________________________________________________________________ Firm's Principal Office Address: __________________________________________________________ ____________________________________________________________________________________ Phone: ___________________ Fax: _____________________ E-mail: _____________________ Nature of advertisement or written solicitation: A. Letter (*Please provide envelope) B. Telephone Directory C. Newspaper/Periodical E. Billboards and other signs F. Post card/ self-mailer D. Television/Radio (*Please provide transcript) G: Other, explain:______________________________________________________________________________________ ________________________________________________________________________________________________________ State the date that the advertisement or writing was first disseminated or mailed: _______________ State where the advertisement is disseminated (i.e. which newspapers, telephone directories, periodicals, television stations, there may be more than one): ________________________________ _____________________________________________________________________________________ (form continued on next page) American LegalNet, Inc. www.FormsWorkFlow.com Does the advertisement or writing disclose or allude to a specific fee, range of fees, or that the lawyer or law firm will render fees on a contingent fee basis? Yes ________ No ________ Does the advertisement or writing disclose the existence of an office other than the firm's principal office? Yes________ No ________ Does the advertisement or writing designate or allude to one or more specific areas of practice? Yes________ No ________ Prior filings: If you have filed a similar advertisement please provide the following information (otherwise leave blank): Advertisement File Number(s): __________________________________________________________ Revision (previous filed advertisement, but made substantive changes) Identify any lawyers depicted in the advertisement: ________________________________________ ___________________________________________________________________________________ Identify any actual employees of the lawyer/firm depicted in the advertisement with job title: ___________________________________________________________________________________ ___________________________________________________________________________________ Identify any actual clients depicted in the advertisement along with such clients' addresses and phone numbers:______________________________________________________________________ __________________________________________________________________________________ Identify any actors and/or spokesperson used in the advertisement:__________________________ ___________________________________________________________________________________ Additional or Substantiating information: __________________________________________________________________________________ ___________________________________________________________________________________ Note: the Advertising Review Committee may request substantiation of any statement or representation made in the submitted advertisement. ATTEST: I HAVE REVIEWED THE ADVERTISEMENT OR WRITING SUBMITTED AS REQUIRED BY NEVADA RPC 7.2A. THE REPRESENTATIONS CONTAINED THEREIN AND THE INFORMATION IN THIS FORM ARE TRUE AND CORRECT. _______________________________________________ Attorney Signature _________________ Date FOR COMMITTEE USE ONLY NO ACTION TAKEN AFTER REVIEW DATE_____________ BY_______________ ADD'L INFORMATION REQUESTED DATE ___________ BY _____________ ADD'L INFORMATION REVIEWED/APPROVED DATE___________ BY _____________ REFERRED TO OFFICE OF BAR COUNSEL WITHIN 30 DAYS OF REVIEW DATE _____________ BY________________ American LegalNet, Inc. www.FormsWorkFlow.com Please note that the Supreme Court amended the Rules of Professional Conduct (RPC) in ADKT No. 445 and the rules became effective on December 13, 2012. You may review the newly adopted and/or amended rules at: http://www.nvbar.org/