registrationform

							                                LAREDO-WEBB COUNTY BAR ASSOCIATION
                                MEMBERSHIP REGISTRATION AND RENEWAL FORM
                                            2011 - 2012
                                  To be a member of the LWCBA you must be an attorney in good standing, licensed to
                                  practice law in Texas and/or any other state. By applying for membership, you are
                                  confirming that you meet these requirements.
“Raising the Bar Together”

Please fully complete this form.

I. Name & Address

__________ ________________________ _________________ __________________
Mr. /Ms. / Judge    Last Name                            First Name                Middle Name or Initial



Date of Birth: ________________ State Bar I.D. No.: ___________________________, _________
                                                       Issuing State

Company Name / Employer:




Mailing Address:




City, State, Zip:




Business Phone: (______) ________- ____________ Business Fax: (______) ________-


Primary E-Mail Address:

                                                                 □ Add this email to the LWCBA listserv (check box)
E-mail Address: (personal email, legal assistant’s email, etc.)

                                                                 □ Add this email to the LWCBA listserv (check box)
E-mail Address: (personal email, legal assistant’s email, etc.)

                                                                 □ Add this email to the LWCBA listserv (check box)
II. Practice Areas
      (please number first three areas by order of concentration for future website search engine advancements, and indicate all others with an X)

___         Appellate Practice & Advocacy                ___        Family Law                       ___         Municipal & Government Law

___         Banking Law                                  ___        Federal Criminal Defense         ___         Oil, Gas & Mineral Law

___         Bankruptcy Law                               ___        Federal Criminal Prosecution     ___         Personal Injury Law

___         Business Law                                 ___        General Practice                 ___         Real Estate Law

___         Commercial Litigation                        ___        Immigration Law                  ___         School Law

___         Constitutional Law                           ___        Insurance Defense                ___         Social Security Disability Law

___         Consumer Law                                 ___        Insurance Law                    ___         State Criminal Defense

___         Contract Law                                 ___        Labor & Employment Law           ___         State Criminal        Defense    –
                                                                                                                 Juvenile

___         Corporate Law                                ___        Malpractice/Professional Liability___        State Criminal Prosecution

___         Estate Planning & Probate                    ___        Mediator                         ___         Tax Collection

___         Other _______________________


III. Certifications (Please list State issued certifications and areas of certification, use considered in future website improvements)
_______________________________________________________________, ___________________ , __________________
Area of Certification                                            Issuing State      Date of Certification


_______________________________________________________________, ___________________ , __________________
Area of Certification                                            Issuing State      Date of Certification


________________________________________________________________, ___________________ , __________________
Area of Certification                                           Issuing State       Date of Certification

IV. Membership Dues
    Please make checks payable to: THE LAREDO-WEBB COUNTY BAR ASSOCIATION

_____                  I am an attorney in private practice and enclosed is my payment of $150.00.

_____                  I am an attorney employed by the Federal Government, State of Texas, County of
                       Webb, the City of Laredo or a Non-Profit Organization and enclosed is my payment of
                       $75.00.

_____                  I am a federal, state, county, municipal judge or other elected official and exempt
                       from paying Bar dues (please state office)

V. LAREDO PLAN
(If you wish to have your name removed from these CPS case appointment list, please add the appropriate
amount to the membership dues )

____                   CPS cases: add $300.00 ($150.00 membership dues + $300.00 Laredo Plan)
Please remit to:

                           LAREDO-WEBB COUNTY BAR ASSOCIATION
                                     Attn: Membership
                                201 W. Del Mar Blvd, Ste. 14
                                    Laredo, Texas 78041

                             For general questions, please contact:

                                  Victor Villarreal, President
                                   Phone: (956) 727-2402
                               E-mail: villarreal@vrlawfirm.com

                                George Altgelt, President-Elect
                                   Phone: (956) 725-4400
                               E-mail: georgealtgelt@gmail.com

             For questions regarding membership dues and payment, please contact:

                                  Eduardo Romero, Treasurer
                                    Phone: (956) 727-2402
                                E-mail: romero@vrlawfirm.com