Request edit access
Bernice Gaines Dorn Black Women Lawyers Association ("BGDBWLA") Membership Form
This document is an application for membership to the BERNICE GAINES DORN BLACK WOMEN LAWYERS ASSOCIATION ("BGDBWLA") and addresses membership dues. Please complete the application in its entirety. Please make your check payable to "BERNICE GAINES DORN BLACK WOMEN LAWYERS ASSOCIATION” or remit payment online to bgdbwla@gmail.com.
Sign in to Google to save your progress. Learn more
Date *
MM
/
DD
/
YYYY
Name
Bar Number *
Business Address *
Business Telephone
Cell Phone
Email Address
Number of Years of Practice
Membership and Dues *
Required
COMMITTEE INTERESTS: Please indicate which Committee you would like to join.

PRACTICE AREAS Please indicate your area(s) of practice below. 

 *
Required
Amount of Payment
Payment Method
Clear selection
Method of Payment
Scan the QR Code to make a payment or mail your check or cash to Bernice Dorn Gaines Black Women Lawyers Association (BGDBWLA) c/o Kemie King, Esq., 633 South Federal Highway,  Suite 200B, Fort Lauderdale, FL 33301.
BGDBWLA QR Code for Zelle
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms