|
Enrollment Fee with Personalized AskALawyer Web ID Page
- $1,200
Plus state taxes, if applicable. |
$100/month OR
$1,000/year*
(*discount if paid
in advance for first year)
|
|
Annual Dues (Includes Email Address, Web and Email Hosting)
- $2,000
Plus state taxes, if applicable.
|
$200/month OR
$2,000/year
|
| MEMBER INFORMATION |
|
Full Name:
|
|
|
Firm Name, if applicable:
|
|
|
Street Address:
|
|
|
City:
|
|
|
State:
|
|
|
Zip Code:
|
|
|
Phone Number:
|
|
|
Fax Number:
|
|
|
Web Site:
|
|
|
Email Address:
|
|
|
Area(s) of Practice:
|
|
|
Year Licensed:
|
|
|
State Licensed:
|
|
|
Local Bar Number*
|
*If you are not a member of your local bar, please join and provide us with
your number. Your enrollment will not be complete until such time. |
|
Do you have any pending disciplinary issues?
|
No
Yes
|
|
If yes, please explain:
|
|
|
Please provide us
with
a 30-50 word bio for your AskALawyer Web page:
|
Here's an example. |
|
Upload your photo here:
|
Images can be JPEG, GIF, TIFF, PNG or PDF. |
| PAYMENT INFORMATION |
|
Credit Card Type:
|
AmEx
Diners Club
Discover
Mastercard
Visa
|
|
Card Number:
|
|
|
|
CIV Number:
|
|
|
|
Expiration Date mm/yyyy:
|
|
|
|
Send me an invoice:
|
Yes
No
|
|
|
|
By checking this box, I hereby agree to participate
in the AskALawyer.com Affiliate Program. I also affirm that all of
the information provided herein is accurate and I give my consent to
charge my credit card account on file for the amounts and at the indicated
intervals as selected by me above. I agree that I have read the Terms & Conditions. |
|
|
|
|
|
|
|