*Name:

Address:

Telephone:   Fax:

Marital Status: Single   Married:

Name of Spouse:

Bar #
Firm Affiliation: Yes   No

Name of Firm:

Address:

Telephone:    Fax:

*Email:

Optional Information:

Education

School       Dates Attended:(mm/dd/yyyy)         Degree Earned:

Honors or Awards:

Membership in other Organizations, Clubs, Professional Societies, Etc.

Name of Organization           Date Admitted:

CERTIFICATION OF DEFENSE LITIGATION

I hereby certify that I am a member of the South Carolina Bar, in good standing with that organization, and that I devote a substantial portion of my time to defense litigation.

Date:
Signature:

RECOMMENDATION FOR MEMBERSHIP

I hereby recommend that be admitted for membership into the South Carolina Defense Trial Attorneys' Association.

Date:
Signature:

 

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