Mark Churchill, RICO Secretary 309-762-3643 contact@ricountybar.com

Application for Membership

First Name

Middle Name

Last Name

Firm/Corporation

Office Address

City

State

ZIP

Office telephone

Fax telephone

Email address

Birth date

Spouse's Name

College

Grad. Yr.

Law School

Grad. Yr.

Type of Practice
PrivateCorporateGovernmentJudicialTitleState's Attorney

Year Licensed in Illinois

ARE YOU LICENSED TO PRACTICE LAW IN ANY OTHER JURISDICTION?
YesNo

Jurisdiction

Date Licensed

GIVE THE NAMES AND ADDRESSES OF AT LEAST THREE PERSONS (OTHER THAN RELATIVES) WHO HAVE KNOWN YOU FOR AT LEAST FIVE YEARS (AT LEAST ONE ATTORNEY OR JUDGE)

1.

Full Name

Address

Occupation

2.

Full Name

Address

Occupation

3.

Full Name

Address

Occupation

HAS EITHER YOUR ABILITY, CHARACTER, OR FITNESS TO PRACTICE LAW EVER BEEN QUESTIONED?
YesNo

HAVE YOU EVER BELONGED TO OTHER BAR ASSOCIATIONS?
YesNo

IN MAKING THIS APPLICATION, I HEREBY AGREE, IF GRANTED MEMBERSHIP, TO OBSERVE THE BYLAWS OF THE ROCK ISLAND COUNTY BAR ASSOCIATION AND TO ABIDE BY THE ILLINOIS CODE OF PROFESSIONAL RESPONSIBILITY.
Yes