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					                Houston Lawyer Referral Service, Inc.
      Application for Mass Tort Experienced Panel Participation
Applicant must be licensed and practicing at least five years prior to
applying. Attorneys Board Certified in Personal Injury Trial Law are
immediately eligible.

Applicant must have handled five (5) Mass Tort cases to resolution
by settlement or verdict within thirty-six months preceding
application. Applicant must have attended 30 hours of CLE in the
are of law within the past three (3) years. Attach list of CLE to
this form.

Approximately the following % of my practice has been devoted to
practicing Personal Injury Law, in Texas, during the past five (5)
years:
_____% 2011   _____% 2010 _____% 2009 _____% 2008 _____% 2007

Provide % of your practice specifically devoted to Mass Tort
matters, in Texas, during the past five (5) years:

_____% 2011     _____% 2010     _____% 2009       _____% 2008   _____% 2007

I have participated in Mass Tort activities listed below to the
extent and in the capacity indicated during the past five (5)
years:
List approximate # of cases handled as:
(L)=Lead Counsel / (C)=Co-Counsel / (S)=Supervisor of Jr. Counsel

(L)____(C)____(S)____     Cases settled prior to institution of suit
(L)____(C)____(S)____     Cases filed/answered on behalf of PI litigant
(L)____(C)____(S)____     Contested pre-trial motions submitted
(L)____(C)____(S)____     Depositions taken
(L)____(C)____(S)____     Cases settled after institution of suit
(L)____(C)____(S)____     Juries selected
(L)____(C)____(S)____     Jury arguments made
(L)____(C)____(S)____     Cases tried to a verdict in a court of record
(L)____(C)____(S)____     Appellate briefs prepared
(L)____(C)____(S)____     Oral arguments presented in appellate courts
(L)____(C)____(S)____     Mass Tort cases tried by Jury
(L)____(C)____(S)____     Mass Tort cases settled
(L)____(C)____(S)____     Mass Tort cases involving 1000+
(L)____(C)____(S)____     Mass Tort cases involving 500+
(L)____(C)____(S)____     Mass Tort cases involving 100+
                               Documentation
List five mass tort matters you have taken to resolution by settlement or
verdict within thirty-six months preceding application. In the Description
area, provide detailed information about your role, overview of case and
results.

1.    Client Name______________________________________________________________
     Description______________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     Date Concluded____________________________    Cause Number_________________



                                                                         PI-MASS
CONTINUED:


     County____________________________________   Judge________________________
     Jury or Non-Jury_________________________________________________________
     Results__________________________________________________________________


2.    Client Name______________________________________________________________
     Description______________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     Date Concluded____________________________   Cause Number_________________
     County____________________________________   Judge________________________
     Jury or Non-Jury_________________________________________________________
     Results__________________________________________________________________


3.    Client Name______________________________________________________________
     Description______________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     Date Concluded____________________________   Cause Number_________________
     County____________________________________   Judge________________________
     Jury or Non-Jury_________________________________________________________
     Results__________________________________________________________________



4.    Client Name______________________________________________________________
     Description______________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     Date Concluded____________________________   Cause Number_________________
     County____________________________________   Judge________________________
     Jury or Non-Jury_________________________________________________________
     Results__________________________________________________________________


5.    Client Name______________________________________________________________
     Description______________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     Date Concluded____________________________   Cause Number_________________
     County____________________________________   Judge________________________
     Jury or Non-Jury_________________________________________________________
     Results__________________________________________________________________


     Attach list of CLE

				
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