Attorney Application

Name

Residence Address

Business Address

Firm Description

Telephone Number

Email Address

Birthdate

Gender (Male/Female)

Degrees held, both academic and law, and schools awarding same, with year of graduation

Name of law firm in which you are a partner or associate and number of years you have been associated with the same

Total numbers of years in practice of law

Date of admission to practice in West Virginia

Do you belong to ATLA (formerly NACCA), WVAJ, or any other similar organization?

If so list the names of such organizations

Do you belong to Defense Research Institute (DRI), the International Association of Defense Counsel, the Federation of Insurance and Corporate Counsel, or any similar organization?

If so, list the names of such organizations

Number of years preceding the date of this application in which you have continuously devoted a substantial portion of your professional time to the representation of defendants in civil litigation

The approximate percentage of your professional time that you are now devoting to civil litigation

Of the percentage of time set forth in answer to above, what percentage of that time is devoted to representation of defendants as opposed to plaintiffs in civil litigation other than domestic relation matters?

Of the total number of civil litigation cases personally handled by you during the past three years, approximately what percentage was on behalf of defendants?

Approximately what percentage was for plaintiffs?

If accepted as a member, I agree to abide by the Charter, Articles of Incorporation, and By- Laws of this Association.

Date

Nominated by Defense Trial Counsel Member