The Dartmouth Lawyers Association
Membership Form

 

INSTRUCTIONS

Print this page and complete form items below. Enclose a check made payable to the "Dartmouth Lawyers Association" for an amount corresponding to the selected membership category below. Mail completed form and check to The Dartmouth Lawyers Association, 4825 Admirals Pointe Drive, Lafayette, IN 47909-8172.

MEMBERSHIP TYPE

Please indicate a membership category and status.

 Category:   ____ Founding ($150) ____ Special ($100) ____ General ($60) ____ New Member ($25) ____ Student ($10)
 Current Status:   __ New DLA Member __ Existing DLA Member

DIRECTORY PROFILE

Please complete only those fields you would like included in the online and print-based Directory of Members. (Date of birth is for record-keeping purposes only and will not be published in the directory.) Online searches require the presence of some professional data. If you are retired and wish your name to be found through online searches, enter "Retired" or "Self-Employed" on the "Description of Practice" line.

 Full Name
 Name at Dartmouth (if different)
 Date of Birth
 Class at Dartmouth
 Description of Graduate Education (List school(s), degree(s), and year(s) received.)
  
  
  
 Name of Business/Firm
 Current Position
 Office Address
  
  
 Office Tel Number(s)
 Office Fax Number(s)
 Office Email Address
 Web Site URL
 Description of Practice, Business, or Profession, including Personal Specialty
  
  
  
  
  
  
 Geographic Area Served
  
  
  
 Home Address
  
 Home Tel Number(s)
 Home Email Address

DIRECTORY SORTING

The print-based Directory of Members is organized geographically. Please indicate within which city and state or country you would like your profile to be listed.

 City, State, Country

CONTACT DETAILS

Please indicate how the DLA may contact you.

 __ Use Business Info __ Use Home Info __ Use Alternate Info Listed Below __ Do not contact me
 Alternate Contact Info (address, telephone, and/or email)
  
  
  

Thanks for your participation and support!