Lawyer Referral and Information Service (LRIS) Panel Membership

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1 Lawyer Referral and Information Service (LRIS) Panel Membership Name: Supreme Court # Address Telephone Fax I am licensed to practice in the following states other than Pennsylvania and the LRIS may direct clients needing representation in these states to me: How would you prefer to receive reports from the LRIS? Mail (Courthouse Box/USPS) Fax LRIS MEMBERSHIP FEES: Fee for one Panel in either Section - $40.00 Additional Panels Section I - $20.00 Additional Panels Section II - Free Amount Enclosed: M You must select a main panel to select sub-panels. M You may select an unlimited number of sub-panels under each main panel. If you do not check a sub-panel, you will not receive referrals in that area. Section I Bankruptcy/Debtor/Creditor _ Foreclosures - Residential _ Collection Issues _ Bankruptcy - Experience Panel Business Law/Corporations _ Formation/Dissolution/Sale of Business _ Securities (SEC) _ Business Litigation _ Franchise/Dealership _ Non-profit Corporations Consumer/Commercial Law _ Banking/Savings & Loan/Credit Union _ Contracts _ Identity Theft _ Lemon Law _ Warranties Criminal Law _ Summary Offenses/Traffic Violations _ Juvenile Proceedings _ Expungement _ Probation/Parole Violation _ DUI _ Felony - Experience Panel Family Law _ Adoptions _ Custody/Visitation _ Divorce _ Domestic Abuse (PFA) _ Grandparent s Rights _ Paternity _ Support _ Change of Name _ Premarital Agreements _ Termination of Parental Rights _ Emancipation Personal Injury/Liability _ Assault/Animal bite _ Auto Accident with injury _ Auto Accident without injury _ Product Liability _ Property Damage _ Slip & Fall _ Slander/Libel/Defamation _ Wrongful Death Professional Malpractice _ Legal _ Dental _ Veterinary _ Medical - Experience Panel Real Estate _ Title/boundary/easement issues _ Landlord rights _ Tenant rights _ Zoning/Condemnation/Eminent Domain _ Neighbor Disputes _ Sale/Purchase Property _ Oil & Gas Leasing/Timber Rights Social Security _ Social Security Disability (SSD) _ Supplemental Security Income (SSI) Wills, Estates & Trusts _ Simple Will Drafting _ Estate Probate _ Power of Attorney _ Guardianship (adult & minor) _ Contesting of Wills/Litigation _ Estate Planning _ Trusts _ Living Wills _ Medicare/Medicaid/Elder Law/ Nursing Home Workers Compensation _ State _ Federal Administrative Law/Agencies/Other _ Military/Veterans _ ICC-Trucking _ PA Unemployment Compensation _ Federal Unemployment Compensation _ Liquor Licensing _ Environmental Law _ Educational Law/School Policies _ Immigration/Naturalization Civil Rights _ ADA _ Discrimination (non-labor related) _ False Arrest/Police Conduct Intellectual Property _ Copyrights _ Patents _ Trademarks Labor/Employment Law _ Benefits _ Discrimination _ Employment Contracts/ Non-compete Clauses _ Harassment _ Pensions _ Wrongful Termination _ ERISA Section II Taxation _ Property Taxes/Assessment Appeals _ Individual Tax _ Business Tax

2 Erie County Bar Association Lawyer Referral and Information Service (LRIS) PANEL MEMBER AGREEMENT FORM S CANNOT BE PROCESSED UNLESS THIS FORM IS COMPLETED The undersigned certifies the following: I am licensed to practice law in the State of Pennsylvania and am a member in good standing. I have read and agree to be bound by the LRIS Rules governing panel membership and hereby acknowledge receipt of the same. I represent that I am competent to handle referrals in the categories I have selected, and I agree to render up to a one-half hour initial consultation to clients referred to me through the LRIS. I agree to remit to the LRIS 10% of total fees paid and collected on all LRIS cases generating over $250. I agree to maintain liability insurance per the LRIS Rules and Procedures and agree to provide a copy of the declarations page of my insurance policy. I agree to notify the LRIS immediately if I no longer have such coverage and to withdraw from the LRIS until I again meet all membership requirements. I agree to participate in the Erie County Bar Association s Pro Bono Program. o I am enrolled. Please send me an application for enrollment. o I will in no event hold or claim to hold the Erie County Bar Association, its members, the LRIS Committee or any officer, trustee or employee thereof, to any liability whatsoever in connection with the use of the information herein contained or the operation of the Service. Professional Liability Carrier: Declaration page of policy # is attached. Expiration date of policy: Attorney s Please return your application, panel fees, agreement form and copy of your insurance declaration page to: Erie County Bar Association - LRIS 302 West Ninth Street, Erie, PA For your records, please maintain the LRIS Rules & Procedures and a copy of this agreement form.

3 In order to be referred felony criminal matters through the Lawyer Referral & Information Service (LRIS), applicants must have handled as lead counsel at least 5 separate felony cases to conclusion within the last five years. CRIMINAL FELONY Criminal Procedure Rule 801 outlines criteria for experience and education for defense lawyers in capital cases. By May 1, 2006, an attorney must have a minimum of 18 hours of approved PA CLE courses relevant to capital cases in order to be eligible for appointment in a capital case. I certify that I am eligible to receive referrals for capital cases. I hereby certify that I meet the membership requirements for receiving referrals from LRIS in the Criminal Felony area.

4 MEDICAL MALPRACTICE In order to be referred medical malpractice matters through the Lawyer Referral & Information Service (LRIS), applicants must have handled as lead counsel at least 5 separate medical malpractice cases to conclusion within the last five years. I hereby certify that I meet the membership requirements for receiving referrals from LRIS in the medical malpractice area.

5 BANKRUPTCY In order to be referred as counsel to a debtor in a Chapter 7, 11, or 13 Bankruptcy Case, an attorney must have been the primary attorney of record and have handled to completion, including Notice of Discharge or Confirmation, five separate cases within the last five years. I hereby certify that I meet the membership requirements for receiving referrals from LRIS in the bankruptcy area.

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