Photo Id Membership Card Application printable pdf download

THE WEST VIRGINIA STATE BAR

PHOTO ID MEMBERSHIP CARD APPLICATION

The Supreme Court of Appeals of West Virginia has approved the State Bar’s use of Photo ID cards,

issued through the West Virginia Department of Motor Vehicles, as the official State Bar identification

card. To obtain the new card you will need to complete the Photo ID Membership Application below:

(Please print)

Name _________________________________________________________________________

Last

First (No initials)

Middle

WV State Bar ID Number __________________________________________________________

Date of Admission ________________________________________________________________

(This information is used by the DMV only and will not appear on your photo ID card.)

Birthdate ___________________________

SSN________________________________

__________________________________________

______________________________

Signature

Date

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Please return this completed Photo ID Membership Card Application to The WV State Bar, Attn: Photo

ID Cards, 2000 Deitrick Boulevard, Charleston, WV 25311. Do not fax or email the form to The State

Bar.

Please note that the DMV office requires a full first name on this application. They will not accept an

application with an initial only in the first name field.

When the State Bar receives your Photo ID Membership Card Application, your information will be

verified and submitted to the DMV. The DMV will assign a number to your application. Once the

DMV application number is provided to you by the State Bar, you can visit any West Virginia DMV

office, with an additional photo ID and $5 (cash, check, credit card or money order), and acquire your

West Virginia State Bar Photo ID Membership Card

DMV Regional Offices can be located by going to

the following link:

Questions? Contact Cheryl L. Petty at the State Bar at 304-553-7229.

For Office Use Only:

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Photo Id Membership Card Application