Attorney Profile


FIRM NAME:
ATTORNEY NAME:
BAR #:
CONTACT PERSON:
ADDRESS:
CITY:
STATE:
ZIP:
TELEPHONE:
FAX:
E-MAIL ADDRESS:
WEB SITE:

Would you be interested in participating
in public relations opportunities, submitting written articles
for publications or do public speaking at benefit enrollment
seminars?

Yes

No

Total years of experience:

Number of attorneys in firm:

List geographic locations or counties to which you are willing to travel to assist clients:

Do you maintain professional liability insurance?


Yes

No

Do you wish to participate in the Individual / Family Plan
Referral Network?

Yes

No

Do you wish to participate in the Small Business Plan Referral
Network?

Yes

No

COMPLETED BY:

DATE:
ATTORNEY SIGNATURE:

Please check the appropriate boxes to indicate
the areas of law that your firm practices:


Administrative Law

Adoption

Agricultural Law

Aviation Law

Business Law

Civil Rights

Commercial Motor Vehicle

Condominium Law

Construction Law

Copyright / Trademark

Corporate Law

Criminal Felony

Custody Issues

Divorce (Simple)

DUI/DWI

Entertainment Law

Environmental Law

Fraud

General Practice

Human Rights

Incompetence / Infirmity

International Law

Juvenile Court Proceedings

Legal Malpractice

Maritime

Medical Malpractice

Mobile Home Law

Paternity

Product’s Liability

Social Security

Support (spouse or child)

Tax / Financial Matters

Wills, Probate, Estates, Trusts

ADA Issues

Admiralty (Maritime)

Appellate

Antitrust Law

Bankruptcy

Civil Litigation

Collections

Computer Law

Contract Law

Consumer Protection

Criminal Misdemeanor Defense

Credit repair


Debt Settlement

Divorce (Contested)

Domestic Partner Issues

Elder Law

Entertainment / Sports

Felony Defense

Foreclosure

Guardianship

Health Care Law

Immigration / Naturalization

Insurance Law

Labor & Employment

Landlord / Tenant

Local Government Law

Loan Modification

Military Law

Personal Injury

Patent Law

Securities Law

Real Estate

Sports Law

Tribal Law

Traffic Ticket Defense

Worker’s Compensation

Please list other areas of practice not
listed above:

Comments of other pertinent information
(Additional office locations, foreign language capability,
etc.):