2004 New Member Application

Dues for new members are only $99.

Your annual dues will provide a variety of benefits, including a 1-year subscription to PaTLA News , valued at $50. Dues are valid to 12/31/2004.

Use this form to become a new member. To renew your current membership dues, please go to Renew. To add a section to your existing membership, go to Sections
Prefix
*First Name
   Middle Initial or Name
 
*Last Name
   Informal(Bob)
 
Suffix
Designation(Esq.)

  
    
*Firm
*Street Address, Suite #

Building Name, P.O. Box
 
*City

 *State

   *Zip Code

  
PA Supreme Court
ID No.(required for Attorneys)
 Year Admitted to Practice
   *County (If outside of PA, select Out of State)
 
Phone#
 Fax#
   *E-Mail (bob@domain.com)

Your home address will be used to identify legislative district
numbers and will only be used by PaTLA. By policy of the PaTLA Executive Committee, we will not sell residential address data
about our members.
Home Address
Home City

 State
 Zip Code

PaTLA Web Site
To access the PaTLA web site, enter a login ID and a password. If you are an attorney in Pa., you are required to use your Supreme Court ID for your login ID. The password must be at least 6 characters in length and must contain both alphabetical and numerical characters. Please remember to write these down before clicking 'Sign - Up'

*Login ID

*Password

Areas of Practice
Automobile
Bad Faith
Civil Rights
Commercial
Criminal
Employment
 Family
Medical Malpractice
Premises Liability
Products Liability
Toxic Torts
Workers' Comp
   
Represent
Plaintiffs
Defendants		 Communication Preference
Email
Fax
Mail
No Preference
   
Firm Size
1 to 2 Employees
3 to 9 Employees
10 or more employees		 Gender (Optional)
Male
Female
   
Member Categories
New Members - $99
1994 or Earlier - $350
1995 - 1998 - $325
1999 - 2001 - $195
2002 - $100
New Bar Admittee - $50

Champion of Justice - $1,500
President's Club - $1,000
Sustaining Member - $500

Out of State Attorney - $125
Law School Professor/Public Interest Attorney- $125
Judicial Law Clerk (full-time) - $95
(Please provide the name of the judge in the 'Firm' field above)
Paralegal (full-time) - $95
Law Student (full-time) - $35

Sections & E-Mail Listservs(Additional) more info...

Automobile Insurance Law $45
Fire/Property Insurance Litigation $25
Insurance Bad Faith $50
Medical Malpractice $100
Workers' Compensation $35
New Lawyers FREE (members in practice less than 10 years)
E-Mail Listserv: Add me to any Section Listserv for which i am eligible.

Payment Method

Credit Card Type
American Express
Discover Card
Master Card
VISA Card

Name on credit card

Credit Card Number

Credit Card Expiry Date


Checks: Make payable to PaTLA Please print this form and mail to PaTLA at the address below.

Amount Payable:   $

           

Important: Your dues payment will not be deductible as a charitable contribution, but will, in general, be deductible for most members as a business expense, exception to the extent provided in the next sentence. Pursuant to the Revenue Reconciliation Act of 1993, Pennsylvania Trial Lawyers Association estimates that 12 percent of your dues payment will not be deductible as an ordinary and necessary business expense because of PaTLA's lobbying activities on behalf of its members.

Questions about this form? Questions about PaTLA membership? Please call PaTLA at (215) 546-6451 or email kyong@patla.org

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