LVNBA Membership Form
Information should be updated annually (each January). It should only take approx. 3-5 minutes to complete this form.
Personal Information
Membership Year? *
(calendar year)
First Name *
Middle Name or Initial
Last Name *
Title, if applicable
Firm or Company, if applicable
Street Address *
City *
State *
Zip Code *
Email Address *
Phone Number *
Please indicate cell, work, or home.
Alternate Phone Number
Please indicate cell, work, or home.
Admitted to Practice *
Member of the National Bar Association *
Current on your LVNBA Dues for this Calendar Year *
Include Your Information *
If you want some information excluded please note that information under "Other."
Required
Type of Practice *
Required
Area(s) of Emphasis *
As defined by the National Bar Association
Required
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