Mark Churchill, RICO Secretary 309-762-3643 [email protected]

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