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This form is to be filled out exclusively by Law Students for Internet Listing.

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
Fax
E-mail
URL
Law School

Date expected to graduate from Law School:

______________________________________________________________________________________

Undergraduate School:

Year graduated from Undergraduate School:

If Graduate School, school and date:


______________________________________________________________________________________

Work References: (name, date of employment, phone)

References

______________________________________________________________________________________

Comments: (Special activities or awards, such as Law Review or any organizations you belong to in Law School, or general information)

__________________________________________________________________________________________

What background color would you like?

A

B

C

D

 

E

F

G

H

 

EXAMPLE of D

Color of text Text on page

Choose two links:

1 http:// 2 http://

Coments about the links:
1 2.

Would you like your E-mail address or Phone number at the bottom of the page?
Please contact me at

Would you like one of these lines at the top of the page?


1

2

3

4 ______________________________________________________________________________

How did you hear about us?

Phone

E-mail

Associate or Friend

Other


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It is unlawful to represent oneself as a licensed attorney if not appropriately licensed under state or other jurisdictional law.
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Last revised: 01/08/02