Membership ApplicationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutTitleOrganizationLayoutCountyCellMember Email *FaxWork PhoneBirth DateLayoutGenderGenderMaleFemaleUsername *LayoutFl Bar No:Law SchoolGraduate School YearMajor(s)Other Bar No:Law School YearUndergraduate SchoolJurisdictionGraduate SchoolUndergraduate School YearArea(s) of Practice/InterestPlease select the committee(s) you would be interested in being a member of:CommitteeAnnual GalaCLECLE for PREvents & PlanningFundraisingGovernanceMembershipMentoringVoter RegistrationMoot CourtCommunity Relations and MarketingDo you know of any other attorneys who might be interested in the PR Bar?LayoutOther Interested AttorneysOther Interested Attorneys EmailWe will include your information in our directories and share with all other members. Thank you for choosing the PRBar!If you choose to mail us your payment, please make check payable to Puerto Rican Bar Association of Florida, Inc., and mail it along with a copy of this form to: Puerto Rican Bar Assoc. of Florida, Inc. 37 N. Orange Ave., Suite 500, Orlando FL 32801.Membership Level: *Florida Attorney - 1 to 10 years experience - $75.00Florida Attorney - more than 10 years experience - $100.00Florida Government or Public Interest Attorney - $65.00Attorney outside of Florida - $65.00Law Student - $25.00Paralegal or Legal Assistant - $35.00Judge or Law Professor - $65.00Honorary Member (Non-Attorneys) - $35.00Pay by Check:NoYesPayment: *CardName on CardLayoutI, Name *, Authorize *to charge my credit card above for the agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.Total$0.00Submit