Lee County Bar Association LAWYER REFERRAL SERVICE

Lee County Bar Association Membership Application June 1, 2014 May 31, 2015 Lee County Bar Association Lawyer Referral Service P.O. Box 1387 Fort Myers, FL 33902-1387 2077 First Street Suite 207 Fort Myers, FL 33901-3087 Phone: (239) 334-4491 Fax: (239) 244-8680 E:mail: lrs@leebar.org www.leebar.org

Lawyer Referral Service Membership Application June 1, 2014 May 31, 2015 The Need For the Lee County Bar Association Lawyer Referral Service There are thousands of Lee County residents of moderate means who appear to under-utilize attorneys. The perceived costs of legal services is one inhibiting factor, but potential users are also often unaware that their problems are legal problems and that lawyers should be employed to resolve them. The Lee County Bar Association Lawyer Referral Service is an ideal way to introduce individuals to lawyers who can provide the legal services they need. Why You Should Participate In the Lee County Bar Association Lawyer Referral Service It is the responsibility of the Bar, and the professional responsibility of every lawyer, to make legal services available to all persons. By participating in the Lawyer Referral Service, you are doing your part in: Helping the public recognize legal problems and the necessity for using a lawyer to solve legal problems; Encouraging the practice of preventive law in solving many potential problems before they become more serious; Providing an opportunity to tell the public that lawyers are willing to help them and that they need not be apprehensive about consulting a lawyer; Helping the public develop a better understanding of the legal system. How It Works Your application information will be maintained in a rotating computer file by lawyer referral service panel. When a call is received by the service, a referral coordinator will determine the type of case and will refer the individual to an attorney in the area of law requested by the individual. The panel member s record will then be automatically rotated to the back of the computer file for the panel just assigned. Panel members agree to provide a free half-hour consultation. The individual is given the name, address and telephone number of the panel member and is advised to contact the panel member to arrange an appointment. The individual is also advised: To inform the panel member s office that this is a Lee County Bar Association Lawyer Referral Service matter; That he/she is entitled to a free half-hour consultation with the panel member; That the panel member will advise whether, based on the information provided by the individual, there is a legal remedy, whether the attorney will handle the matter, and the costs and fees involved in the representation. Following the referral, the LCBA Lawyer Referral Service will send a referral notice to the panel member s office and send a monthly status report each month. Lawyer Referral Service Special Features Separate phone line (239-334-4491) dedicated to Lawyer Referral Service. Operating hours from 9:00 am to 12:00 noon and 1:00 pm to 4:00 pm, Monday through Friday. Full-time employee devoted to the efficient operation of the Service. Yellow Page advertising. Provides a source for new individuals. Membership Criteria Any Florida Bar member in good standing with no pending probable cause findings by a Florida Bar Grievance Committee who maintains a physical office in Lee County is eligible for membership in the service. Panel members must carry malpractice (E & O) insurance in the minimum amount of $100,000 and furnish a copy of

Membership Application June 1, 2014 May 31, 2015 the insurance policy or a certificate of insurance to the Service upon request. Membership Fee If the prospective panel member is a member of the Lee County Bar Association, the annual fee is $150.00. If the prospective panel member is not a member of the Lee County Bar Association, the annual fee is $450.00. The membership fee is a nonrefundable, non-prorated annual membership fee due each year (June 1 May 31) or any portion thereof. How To Join Complete the application at the back of this document. Mail the application, the membership fee and a copy of the face sheet/declarations page of your current professional liability insurance policy (must indicate the amount of coverage and the expiration date of the coverage) to: Lee County Bar Association, P.O. Box 1387, Fort Myers, FL 33902-1387. Preface The primary purpose of the Lee County Bar Association Lawyer Referral Service is to provide a method whereby any person who can afford to pay a reasonable fee for legal advice or representation be referred to a member of the Service who is available to give a brief consultation and where necessary, furnish additional legal services on a reasonable fee basis where necessary. ARTICLE I THE COMMITTEE The Lawyer Referral Service Committee of the Lee County Bar Association is charged with the organization and operation of the Service and shall make such rules for the conduct and operation of the same as from time to time it may deem proper, subject to the approval of the Executive Council of the Lee County Bar Association. The Association s President shall appoint the Chair of the Committee. ARTICLE II RULES OF THE SERVICE 1. All members in good standing of The Florida Bar with no pending probable cause findings by a Florida Bar Grievance Committee who maintain a physical office in Lee County are eligible for membership in the Service. 2. A lawyer may apply for membership in the Service by completing an application. Upon admission to the Lawyer Referral Service, the panelist agrees: (a) That if a member of the Lee County Bar Association, he/she pay an annual registration fee of $150.00 for receiving referrals in up to a maximum of five categories. That if not a member of the Lee County Bar Association, he/she pay an annual registration fee of $450.00 for receiving referrals in up to a maximum of five categories. (b) To pay an additional 10% of the total fees received from a referred individual on the referred matter on fees over $500 (except in Low Fee matters). However, if a percentage fee is for general representation (such as general corporate work) rather than a specific matter, the obligation for additional contributions shall apply only to fees earned for the services performed within the first year after the referral. (c) To personally grant an initial half hour consultation in person, via telephone, or by written communication to a referred individual at no fee. (d) To report promptly to the Service, on forms to be furnished by the Service, the disposition or status of referred matters and fees received for services in connection therewith and to promptly pay all additional contributions to the Service when due upon receipt of said fees from the individual. Consistent failure to comply will result in suspension from panel rotation until reporting requirements have been met. (e) To maintain malpractice (E & O) insurance in the minimum amount of $100,000, to furnish a copy of the insurance policy or a certificate of insurance to the Service upon request, and to hold the Lee County Bar Association harmless from any claim made against it by a referred individual on account of the member s alleged negligence or mistake. (f) To accept referrals in at least one of the specific areas of practice listed on the Lawyer Referral Service Panel Selection form.

Membership Application June 1, 2014 May 31, 2015 (g) A member shall not forward a matter referred by the Service to another lawyer. However, a member may permit a law firm associate, partner, or professional association member to conduct the necessary legal services under such member s guidance if the assisting lawyer is also a member of the Service and on the same area of practice list. The original attorney continues to be responsible for all reporting and fees associated with the individual. (h) To specifically abide by The Rules Regulating the Florida Bar Rule 8-2.2 (3), The Attorney Referral Service shall agree to maintain an alphabetical member list, updated quarterly, with The Florida Bar. In turn, The Florida Bar shall notify the Service of any unresolved finding of probable cause against a member. When probable cause has been found at the local Grievance Committee level, and the lawyer referral service has been notified, such service shall be required to hold referral to the member in question until the matter is resolved. If the member is in good standing with The Florida Bar after the resolution of the matter, then the member may return to the service. ARTICLE III OPERATION OF THE SERVICE 1. The Service shall be staffed by one or more Coordinators who shall function under the supervision of the Committee and the Executive Director. 2. The staff shall maintain a separate list of members for each area of practice specified in Article II, Paragraph 2(f). Prospective referred individuals shall be interviewed by a Coordinator. If legal services are requested, the Coordinator shall refer the individual to a member in the appropriate practice area. 3. The individual will be required to pay a $50.00 administrative fee (or free for low fee cases). We do not charge an administrative fee for medical malpractice or personal injury cases. The payment will be required to be received in the LCBA Lawyer Referral Service office before the name of the attorney is given to the individual. 4. The referral procedures shall assure that each referral is made in a fair and impartial manner to a member of an appropriate panel. Such procedures shall respond to all circumstances of the individual/applicant, including the subject, the legal problem presented, geographical convenience, language needs and ability to pay for desired services. 5. Assignment of referral individuals shall be by rotation from the appropriate panel unless the individual shall decline to be referred to a particular member, in which case the individual shall be referred to the next member on such panel. Any member passed over in this manner shall remain in position for the next referral for that panel. 6. If the Coordinator ascertains that a person being interviewed is presently represented by a lawyer in the same matter, the member to whom the referral is made shall be informed of the circumstances and shall be governed by the Code of Professional Responsibility. 7. The Coordinator shall provide an attorney s name, address and phone number and instruct the individual to contact the attorney for an appointment. The caller is further instructed to inform the attorney s office that he/she was referred by the Lee County Bar Association Lawyer Referral Service. Upon making such an appointment, the member receiving the referral shall go to the end of rotation for that panel. A confirmation of the referral will be e-mailed or faxed, depending on preference, to the Lawyer Referral Service member. 8. No referrals shall be made to a member who fails to comply with any of the provisions of Paragraph 2 of Article IV. The Committee or Executive Director shall notify a member, in writing, of any non-compliance, specifically describing the nature of such member s non-compliance and, upon compliance, such member shall become entitled to receive referrals. 9. The Referral Service shall make regular and consistent attempts to follow-up with referred individuals in order to obtain information which will enable the Service to ascertain whether appointments have been kept, whether the referred individual was satisfied with the lawyer s handling of the case, whether the fee was within the individual s means and similar information. Information obtained by such follow-up procedures will be used to make such alterations in the operation of the Service as may appear desirable to the Committee.

Membership Application June 1, 2014 May 31, 2015 10. Any committee changes to any or all Lawyer Referral Service Rules and/or procedures will be duly distributed to all Lawyer Referral Service member attorneys. ARTICLE IV REMOVAL FROM THE SERVICE 1. No member of the Service shall be removed from membership in the Service without having been afforded notice and an opportunity to be heard by the Committee and an opportunity to show cause why such member shall not be removed from membership, except as provided for in Paragraph 4 below. 2. A majority of the Committee may remove a member from the service for cause upon the following grounds: (a) Failure to pay registration fees and/or dues; (b) Failure to pay rebates when due; (c) Consistent unavailability for any reason other than illness; (d) Consistent refusal to make or keep appointments with referred individuals; (e) Failure to comply with the Rules of the Service; (f) Failure to meet the qualifications for membership in the Service; (g) Incompetence; and/or; (h) Suspension or disbarment from The Florida Bar. (i) Failure to comply with the Rules Regulating The Florida Bar Chapter 4, Rules of Professional Conduct and The Standards of Professional Courtesy and Conduct for Lawyers Practicing in the Twentieth Judicial Circuit (as reflected in Administrative Order No. 2.20). 3. A member may at any time withdraw from the membership upon written notice to the Committee, but any resigning member shall not thereby be relieved of obligations to pay percentage fees to the Service in connection with any out- 4. A member shall be automatically suspended from membership in the Service upon notification to the Service from the Ethics and Discipline Department of The Florida Bar that a finding of probable cause or complaints has been made against said member and that suspension shall remain in effect until the grievance matter is resolved. If the member is in good standing with The Florida Bar after the resolution of the matter, the member may return to the service. ARTICLE V PUBLICIZING THE SERVICE The Committee shall publicize the existence and purpose of the Service through proper channels, preserving the anonymity of its members, to the end that the availability of competent and conscientious legal assistance shall be known to those who can afford to pay a reasonable fee for legal services. ARTICLE VI LOW FEE PANEL A Low Fee Panel, also known as Modest Means Panel, shall be maintained by the Service, the purpose of which is to make available legal representation at a reduced fee provided the following criteria is met: The individual qualifies according to the Service rules based on income and assets not to exceed 200% of the federal poverty guidelines; Service Coordinators have determined the individual s eligibility per the individual s verbal affirmation of eligibility. Low Fee Panel Participating Attorneys: May not switch a referred individual to low fee unless the individual completes the application with the Service. Legal fees will be at reduced rates. No percentage fees (10% over $500.00) are due the Service for approved Low Fee cases.

INDIVIDUAL ELIGIBILITY LOW FEE PANEL In an effort to meet the varied legal needs of the public, the Lee County Bar Association Lawyer Referral Service has established a Low Fee Panel. Your decision to join the Low Fee Panel will help meet the profession s responsibility of providing legal services to all Lee County residents. The individual qualifying for referral through this panel is entitled to a free 30-minute initial consultation. Participating attorneys then will consider the individual s financial obligations when determining additional fees for legal services. If the legal problem is one that can be handled easily, such as a will or an uncontested divorce, and the individual is genuinely in need of reduced rates, the fee should be lower than your regular rate. The suggested rate is one-half your regular rate. Participating attorneys are encouraged to use a payment plan or another method of assisting the individual in paying legal fees. Initial determination of an individual s eligibility for this program is made by the Lawyer Referral Service Coordinator. Further determination of eligibility is to be made by your office during the initial consultation. If the attorney determines that the individual has an income exceeding the Low Fee Panel guidelines, or is financially able to pay reasonable attorneys fees, additional fees for legal services should be at the attorney s regular fee. Feegenerating cases, such as personal injury cases or any other tort cases, are not part of this reduced fee program and should, therefore, be handled through regular billing procedures. The income eligibility guidelines for the Low Fee Panel are as follows: Family Size Yearly Gross Income PANEL MEMBERSHIP 1 $11,170.00 2 $15,130.00 3 $19,090.00 4 $23,050.00 5 $27,010.00 6 $30,970.00 7 $34,930.00 8 $38,890.00 Any member in good standing of The Florida Bar with no pending probable cause complaints with The Florida Bar or the Supreme Court of Florida, who joins the Lee County Bar Association Lawyer Referral Service on the Regular Panel, is eligible to participate on the Low Fee Panel. There is no extra charge for panel membership on the Low Fee Panel. If you wish to participate on the Low Fee Panel, please so indicate on the Membership Application. As an attorney participating on the Low Fee Panel, you must agree to abide by the rules and regulations of the Lee County Bar Association Lawyer Referral Service, including carrying and continuing to carry $100,000 of professional liability insurance. The Lee County Bar Association Lawyer Referral Service will refer individuals to participating attorneys on a rotation basis according to the type of case.

Lee County Bar Association Lawyer Referral Service Membership Application LCBA Member- $150.00 per year I do not currently belong to the LCBA- $450.00 per year Name: Phone: Fax: Street Address: City: Zip: Mailing Address: City: Zip: E-Mail Address: Date of Admission to The Florida Bar: Law School & Date of Graduation: Florida Bar #: I am admitted to practice in state/federal: Date: Date: I am board certified by The Florida Bar in: Date: Date: Yes No There are/was, or have been in this state or elsewhere, a felony conviction, disbarment, suspension or disciplinary action against you? (If Yes, give details on a separate sheet.) I will: Take evening or weekend appointments: Yes No Handle cases outside Lee county (list counties): Yes No Make calls to jail: Yes No Make calls to hospitals: Yes No Make house calls in special circumstances (e.g. elderly, handicapped) Yes No I speak/read these foreign languages: I know sign language for the hearing impaired: Yes No My office is accessible to handicapped persons: Yes No

OATH I HEREBY APPLY FOR MEMBERSHIP in the Lee County Bar Association Lawyer Referral Service (LRS), a copy of which is provided with this application, and the Rules Regulating The Florida Bar Chapter 4, Rules of Professional Conduct and the Standards of Professional Courtesy and Conduct for Lawyers Practicing in the Twentieth Judicial Circuit (Administrative Order No. 2.20). The text can be found at: http://www.ca.cjis20.org/pdf/ao/ao_2_20.pdf. I will abide by the Rules of the Lee County Bar Association Lawyer Referral Service (LRS), a copy of which is provided with this application. I will accept all referrals for an initial half-hour consultation within my areas of practice, as indicated on the Areas of Practice Selection Form attached to this Application for Membership, which I will personally conduct. I understand that membership in the LRS is personal and is not made on behalf of my firm or any of my associates. In the event I am not able to accept representation of an individual for any reason, I agree to refer the person back to LRS for reassignment. I am competent to handle matters in the areas of law which I have indicated. Any charge for services following the initial half-hour consultation, including contingent fee matters, will be agreed upon between the individual and myself. I will remit to LRS 10% of all fees of more than $500.00 earned on matters referred by LRS, except those matters referred under the Low Fee Panel in which case no percentage fee is due to LRS. I am and will remain covered by professional liability insurance with a minimum charge of $100,000, for as long as I am a member of LRS. I will notify LRS immediately upon any lapse of such insurance. I understand that should my insurance lapse, I will no longer receive referrals. A copy of my current malpractice insurance policy declaration page is attached. I will comply with the periodic reporting requirements concerning the status of referred individuals. I understand that consistent failure to comply will result in suspension from panel rotations until reporting requirement have been met. I will participate in fee arbitration before the local Florida Bar Fee Arbitration Committee concerning any disputed fee with an LRS-referred individual, if the individual so desires. I understand that LRS will be relying upon the representation made by me in this application in making referrals, and I certify that the information given is true and accurate. I will promptly report any changes of circumstances which may materially affect the accuracy of the information provided in the application. I am a member of the Lee County Bar Association and have enclosed a check payable to Lee County Bar Association in the amount of $150.00 for membership in the LCBA Lawyer Referral Service. I am not a member of the Lee County Bar Association and have enclosed a check payable to Lee County Bar Association in the amount of $450.00 for membership in the LCBA Lawyer Referral Service. Signature: Florida Bar Number: Date: APPLICATION MUST BE ACCOMPANIED BY PROOF OF REQUIRED INSURANCE AND PAYMENT IN FULL

LEE COUNTY BAR ASSOCIATION PANEL SELECTION FORM Select a maximum of five major areas with an unlimited number of sub-categories. Only select areas for which you wish to receive referrals under the terms of the Lawyer Referral Service Rules and in which you concentrate your practice. ADMINSTRATIVE & GOVERNMENT City/County/State Dept. of Insurance Disability DPR and FREC Educational Law Employment Benefits Florida Sales Tax Licensing Medicare/Medicaid Public Utilities School Law Social Security Unemployment Veterans Right Welfare Problems ADMIRALTY LAW Contracts Tort Claims APPELLATE Civil Criminal ARTS AND HUMANITIES AVIATION LAW BANKRUPTCY Debtors Chapter 13 Debtors Chapter 7 Representing Creditors Representing Debtors CIVIL LITIGATION Claims Collections All Areas Collections County/Cir. Collections Defense Collections Sm. Claims Construction Contracts Defense Ecclesiastical Law Foreclosure Lemon Law/Auto Problems Libel Slander Personal Property Small Claims Tax Controversies CIVIL RIGHTS LAW Americans with Disabilities Act Baker Act Marchman Act Myers Act Criminal Related Discrimination Wrongful Arrest COMPUTER LAW Cyber Law Internet Law CONSUMER RIGHTS LAW Banking Collections- Defense Credit Garnishment Internet Repossessions Tenant Rights Warranties CORPORATE & BUSINESS Anti-Trust Commercial Litigation Construction Litigation Contracts Customs Franchising Incorporation/Partnership Mechanics Lien Nonprofit Organizations Pension & Profit Sharing Purchases/Sales Securities CRIMINAL LAW Domestic Violence DUI Federal Felony Juvenile Misdemeanor Parole/Probation Prisoners Rights Traffic ELDER LAW Specific Area ENTERTAINMENT & SPORTS Music Sports ENVIRONMENTAL LAW Specific Area ESTATE PLANNING, PROBATE & GUARDIANSHIP Baker Act Complex Estate Planning Durable Power of Attorney Elder Law Guardianship Litigation Living Trust Living Wills Marchman Act Myers Act Probate Senior Will

Simple Wills Testamentary Trusts Wills & Trusts IMMIGRATION LAW Naturalization INSURANCE LAW Auto Disability Disability Long Term Health PIP Property Subrogation INTELLECTUAL PROPERTY Litigation Patent Trademark or Copyright INTERNATIONAL LAW LABOR & EMPLOYMENT Americans with Disabilities Benefit Problems Discrimination Employment Contracts ERISA Harassment Labor Relations Pension Representing Employees Representing Employers Unemployment Wrongful Termination LANDLORD/TENANT Landlord Tenant MALPRACTICE Dental Legal Legal ONLY in other counties Medical MARITAL & FAMILY Adoption Annulment Child Custody/Visitation Child Support Delinquency Dept. of Children & Families Dependency Dissolution Contested Dissolution Uncontested Domestic Abuse Emancipation Grandparents Rights Guardianship Name Change Paternity Pre/Post Nuptial Agreements Separation Support Enforcement MILITARY LAW Specific Area PERSONAL INJURY & NEGLIGENCE Automobile Accidents Defense Nursing Home Neglect Plaintiff Products Liability Property Damage REAL PROPERTY Commercial Real Estate Condo & Time Shares Condo Associations Condo Litigation Eminent Domain/Condemnation Foreclosure Homeowner s Association Land Trust Liens Litigation Mobile Homes Property Transfer Sales & Leases Zoning/Land Use/Permits SECURITIES Arbitration Litigation SOCIAL SECURITY Disability SSI TAX LAW Corporate Employment Individual Litigation State/Federal WORKERS COMPENSATION Federal Representing Individual Representing Employer State Local ************************************ LOW FEE PANEL I agree to accept Low Fee cases in the areas of practice I have selected above. ************************************