EABA APPLICATION

Please complete the APPLICATION below

Name

First Name

Last Name

Cell Phone

Legal Profession Category

Please one that applies.

Licensing Jurisdiction and Bar No.

Please provide the Jurisdiction (State/Province/Territory of US or CA) in which you are licensed in AND Bar Number, if applicable. If this does not apply to you, write N/A.

Firm Name

Please provide name of the firm/agency in which you work at. Write N/A if not applicable.

Law School Attended

Please provide the law school you attended. If not applicable, write N/A.

Law Degree Attained

Please select one/more that applies.