Thank you for your interest in applying for LeGaL's Lawyer Referral Network or Pro Bono Panel.

Please complete this questionnaire to submit your application. This process typically takes less than 10 minutes. Note that you may be asked to upload a recent version of your resume.
If you have questions about this application, please call LeGaL at 212-353-9118.
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Which panels are you interested in joining? You may select more than one. *


 
Please upload a recent copy of your resume for our records. *

 
What is your first name? *

 
What is your last name? *

 
What is the name of your firm? *

 
Office Address

 
Address Line 1 *

 
Address line 2

 
City *

 
ZIP code *

 
Business phone *

 
Cell or Home Phone

 
Office Email Address *

 
Business Fax

 
What is your date of birth?

 
Education (list each college, law school and post graduate school attended, years attended, and degree and year received:

 
When were you admitted to practice and within what state? *

 
Admissions to practice before other courts and jurisdictions (federal, administrative, etc.) and dates of admissions:

 
Please provide dates and explain any gaps in active legal practice since admittance: *

 
List areas of law in which you have concentrated your practice during the past five (5) years and for which you would like to receive referrals: *

 
State the approximate percentages of your practice during the past five years devoted to:

 
Trial work

 
Transactional work

 
Mediation

 
Arbitration

 
Other (please explain)

 
Have you ever been admonished or disciplined or are you now under investigation concerning any allegation of professional misconduct or wrongdoing? *


 
Please explain

 
Have you ever been disciplined, suspended and/or removed from a lawyer referral panel? *

     
 
Please explain

 
Have you ever been sued by a client? *

     
 
Please explain

 
List proficiency, including level of reading, speaking and writing (beginner, intermediate, advanced, or native), for any languages other than English. *

 
State the average number of pro bono hours per year you have donated in the past five (5) years, whether you are willing to donate pro bono hours in the future and if so how much and in what capacity, and whether you are interested in participating in a low bono panel for clients of moderate means: *

 
List any law review articles or other pertinent legal publications which you have written, and any pertinent lectures, trainings or continuing legal education courses you have given: *

 
List any other information pertinent to this application:

 
Professional liability insurance covering your practice is required to be listed with the Network. Please provide the name, address and phone number of your insurance carrier, the policy number and the dates of coverage:

 
Please list 3 professional references and provide contact information for each. *

 
I certify I am qualified to handle matters in the areas of law listed in my application and I will refer the matter back to the Network if I am referred a matter for which I do not have sufficient expertise. *

     
 
CERTIFICATION FOR MEMBERSHIP WITH THE NETWORK AND AUTHORIZATION TO DISCLOSE INFORMATION *

I hereby certify that I am a member in good standing of the Bar of the State of New York. I actively practice law at the office address set forth in this Application.

The statements and other information in this Application are true and complete. I agree to notify the Network promptly in writing if anything occurs while I am a member of any of the Network’s panels which makes any such statement or information untrue or inaccurate. Without limiting the foregoing, I agree to notify the Network in writing if my professional liability insurance is terminated or decreased, or if I have been cautioned, admonished, reprimanded, or disciplined by any disciplinary or grievance committee, agency or court, or if I am currently under investigation concerning any allegation of professional misconduct or wrongdoing, or whether I am a defendant in any lawsuit filed by a client or former client.

I consent that information about me in this Application or otherwise known to the Network may be furnished to clients seeking referral by the Network.

I have received and read the Network’s Rules for Panel Membership made effective [April 13, 2016]. I agree to abide by the Network’s Rules as in effect from time to time. Without limiting the foregoing, I agree that in the event of any fee dispute between me and any client referred to me by the Network, at the client’s request and discretion of the Committee, such dispute shall be submitted to binding arbitration in accordance with the Network’s Rules then in effect and if such dispute is submitted to binding arbitration, judgment may be entered on the bases of the decision in such arbitration.

I agree that my membership in the Network is subject to the discretion of the Committee in accordance with the Rules as in effect from time to time.

I authorize the Network, acting through the Committee or Legal Director of the LGBT Bar Association of Greater New York, while I am a member of the Network, to request and obtain any information deemed by the Committee or Legal Director relevant to my membership in the Network, including without limitation any information in the possession of any judicial or other governmental agency, bar association, committee or other entity however constituted or designated which may be concerned with allegations of professional conduct or ability of lawyers or fee disputes with lawyers. I hereby authorize any such agency, committee or entity to release any such information to the Committee or Legal Director upon receipt of an electronic or facsimile copy of this Certification and my signature and acknowledgment below.

I further acknowledge and accept the Terms of Service of the Network's online referral service platform, available at https://lgbtgny.legal.io/terms_of_use.
     
Thank you for submitting this additional information! 

A member of the LeGaL team will be in touch soon.
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