ALABAMA DEFENSE LAWYERS ASSOCIATION

MEMBERSHIP APPLICATION

(Please Print)

I desire to become a member, and I understand that my application must be approved by the officers and membership committee of ADLA. If accepted for membership, I hereby consent to receive communications generated from the ADLA membership roster and delivered via U. S. Mail, fax, e-mail, and any other electronic means. Enclosed is a check for:

(a)_____$125.00 if I have been admitted to practice less than 5 years. ) Each includes a one-time

(b)_____$175.00 if I have been admitted to practice 5 years or more. ) initiation fee of $25.00.

NAME______________________________________________________SPOUSE______________________

NAME FOR NAMEBADGE____________________E-MAIL ADDRESS____________________________

FIRM_____________________________________________________________________________________

OFFICE MAILING ADDRESS_______________________________________________________________

__________________________________________________________________________________________

OFFICE PHONE__________________________________FAX_____________________________________

DATE ADMITTED TO BAR________________________BIRTHDATE_____________________________

ASB NO._________________________________________LAST 6 DIGITS OF SS NO._________________

LIST EACH DEFENSE COUNSEL ORGANIZATION AND CLAIMANTS' COUNSEL ORGANIZATION (INCLUDING ALABAMA TRIAL LAWYERS ASSOCIATION) TO WHICH YOU BELONGED IN THE PAST FIVE YEARS. LIST ANY OFFICE HELD.

__________________________________________ __________________________________________

__________________________________________ Are you a member of DRI? _________

PERCENTAGE OF YOUR PROFESSIONAL TIME NOW DEVOTED TO CIVIL LITIGATION = _________%

PERCENTAGE OF YOUR CIVIL LITIGATION TIME NOW DEVOTED TO REPRESENTING THE DEFENSE = ________%

HAVE YOU EVER:

APPLIED FOR MEMBERSHIP IN THIS ASSOCIATION? ________BEEN A MEMBER OF THIS ASSOCIATION?_______

HOME ADDRESS__________________________________________________________________________

HOME PHONE_________________________________

_______________________________________________ __________________________

APPLICANT SIGNATURE DATE

WE, THE UNDERSIGNED MEMBERS OF THE ASSOCIATION, RECOMMEND THE APPLICANT FOR MEMBERSHIP.

(Must have two sponsor signatures before the application will be submitted to the membership committee for approval.)

__________________________________________ __________________________________________

PLEASE PRINT NAME PLEASE PRINT NAME

__________________________________________ __________________________________________

SPONSOR SIGNATURE SPONSOR SIGNATURE

Please return one completed form with check to : ALABAMA DEFENSE LAWYERS ASSOCIATION

Edwin K. Livingston, Executive Vice-President

4269 Lomac Street

Montgomery, Alabama 36106

334-395-4455