PRO BONO BANKRUPTCY PANEL by gregory1

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									                         PRO BONO BANKRUPTCY PANEL
                                      REGISTRATION FORM

                                                                     DATE:     _____________________

NAME:           ______________________________                       TEL. NO. (      )

FIRM:           ______________________________                       FAX. NO.(       )

ADDRESS:        _________________________________________________________________
                _________________________________________________________________
                _________________________________________________________________


LEGAL MALPRACTICE CARRIER ______________________________________________
POLICY NO. _________________________  EXPIRATION DATE _________________


LEGAL SERVICES OFFICE PREFERRED _________________________________________
(If not listed below)

Legal Services Agencies:      (Circle office(s) you would like to work with)

        Bergen County Legal Services                        Hunterdon County Legal Services Corp.
        Camden Regional Legal Services, Inc.                Legal Aid of Mercer County
                Camden County, Burlington County            Legal Aid Society of Morris County
                Cumberland and Salem Counties               Middlesex County Legal Services
                Gloucester County                           Millville Legal Aid Society
        Cape-Atlantic Legal Services                        Ocean/Monmouth Legal Services, Inc.
        Community Health Law Project (Mercer County)        Passaic County Legal Aid Society
        Essex County Legal Aid Association                  Somerset-Sussex Legal Services Corp.
        Essex-Newark Legal Services                         Union County Bar Association Legal Aid
        Hudson County Legal Services                        Union County Legal Services

AREAS OF INTEREST: CHAPTER 11 _____ CHAPTER 7 _____ CHAPTER 13 _____ OTHER _______
FOREIGN LANGUAGE FLUENCY IN: __________________________________________________________

COMMENTS: _______________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________


                        Return to:       Gary K. Norgaard, Esq.
                                         Stern, Lavinthal, Frankenberg & Norgaard, LLC
                                         184 Grand Avenue
                                         Englewood, New Jersey 07631
                                         Phone: (201) 871-1333
                                         Fax: (201) 871-3161


                                                                     THANK YOU!
J:\WPDOCS\GARY\PROBONO\PROBONO.99\PROBONO.REG

								
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