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    VERMONT BAR ASSOCIATION
LAWYER REFERRAL SERVICE APPLICATION

First Name _____________________ Middle Initial ___ Last Name ___________________________
Firm/Organization __________________________________________________________________
Address __________________________ City _________________ State ____ Zip Code _________
Phone _____________________ Fax _________________ Email ____________________________
 
LOCATIONS
Addison
Chittenden
Grand Isle
   New York
   Rutland
Windsor
Bennington
Franklin
Lamoille
   Orange
   Washington
Caledonia
Essex
New Hampshire
   Orleans
   Windham
CASE TYPES
Adoptions
Criminal/DWI
International Law
Real Estate
Arbitration
Criminal/State
Juvenile Law
Real Estate/Condominium Law
Arts Law/Publishing
Criminal/Federal
Landlord/Tenant
Real Estate/Commercial
Arts Law/Entertainment
Education Law
Landlord Only
Real Estate Litigation
Banking Law
Educ. Law/Special Education
Legal Malpractice
Securities
Banking Law/Commercial
Elder Law
Mediation
Social Security Disability
Bankruptcy
Employment Law
Mediation/Domestic
SSI
Bankruptcy/Creditor
Employment/Labor Relations
Medicaid
Taxation
Business/Partnerships
Employment/Unemployment
Medical Malpractice
Taxation, Property Tax
Civil Rights
Environmental Law
Mental Health Law
Tort & Negligence
Civil Unions
Estate Administration
Military Law
Trademarks
Collaborative Family Law
Family Law
Military Family Law
Traffic
Collection
Family Law with DCF
Municipal Law
Wills & Trusts
Construction Law
Consumer Complaints
Family Law/No Custody
Foreclosure
Non-Profit
Patents
Workers’ Compensation
Zoning
Contract
Guardianship
Professional Licensing
Copyright
Immigration
Public Health
 
Intellectual Property
 
________________________________________________________________________________
PLEASE INCLUDE COPYOF DECLARATIONS PAGE FROM YOUR
PROFESSIONAL LIABILITY INSURANCE POLICY

 
I carry Professional Liability Insurance in the amount of $___________________________
I have read and agree to the terms of the Vermont Bar Association Lawyer Referral Service Rules available at www.vtbar.org.
I agree to hold the Vermont Bar Association harmless from claims by Vermont Bar Association Lawyer Referral Service Clients referred to me.
I hereby certify competency in any area of law in which I am seeking referrals, subject to Rule 1.1 of the Rules of Professional Conduct.
 
___________________________________________________________________ _____________________________________
                                                    Signature                                                                                                    Date
 
                         Individual Attorney - $70                                             Law Firm Rate (5 lawyers or more) - $325
 
PAYMENT METHOD
Check made payable to Vermont Bar Association
Credit Card: MasterCard Visa Discover American Express

Credit Card #_________________________________________________ Exp.Date ________________

Cardholder __________________________________________________________________________

Signature __________________________________________________________________________
Please print completed form & mail with payment & declarations page to:
Vermont Bar Association, PO Box 100, Montpelier, VT 05601-0100